Palmetto Plain

Federal · Final rule, Transparency in Coverage

Health plan price transparency: insurers must give cost estimates by phone, and published price files change format

Final rule Oct. 6, 2026 ยท Effective Dec. 7, 2026

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The short version

  • Under federal "Transparency in Coverage" rules, most private health plans must give members cost-sharing estimates for covered services and publish their negotiated prices in machine-readable files.
  • The new rules add a third way to get your estimate: by phone, in addition to the online tool and paper. A plan may limit phone requests to no fewer than 20 providers per day, but must tell you if it does.
  • Price files will be updated quarterly instead of monthly. They will add details such as product type and provider network name, drop rates for providers unlikely to perform a service, and include a footer and contact text file that make them easier to find.
  • The rules take effect December 7, 2026. The consumer-tool changes apply for plan years starting on or after January 1, 2027. Meeting the phone requirement also satisfies the No Surprises Act's price-comparison-by-phone requirement.
Status
Final rules published Oct. 6, 2026; effective Dec. 7, 2026. The consumer cost-sharing tool changes apply for plan (or policy) years beginning on or after Jan. 1, 2027.
Official source
Federal Register, 91 FR 63748 (Oct. 6, 2026), FR Doc. 2026-20447, "Transparency in Coverage"

What it does

  • Phone access. The rules require “pricing information that is made available through an online consumer tool and on paper (upon request), to also be made available by phone.” (Final rules, Summary) Plans and issuers may limit disclosures to “no fewer than 20 providers per day” by phone, and separately by paper, and must tell you about the limit when you call. (Final rules, section on phone disclosures)
  • No Surprises Act. Meeting this requirement also satisfies section 114 of the No Surprises Act, which requires price comparison guidance by phone and an online price comparison tool. That includes grandfathered plans, which are not otherwise covered by these rules. (Final rules, Summary)
  • Price files. The in-network rate and out-of-network allowed-amount files will have:
    • new contextual files and data elements, such as product type, provider network name and network identifier
    • a changed aggregation level
    • no in-network rates for “unlikely provider-to-service mappings”
    • a longer reporting period and lower claims threshold for out-of-network historical data
    • a reporting cadence reduced from monthly to quarterly
    (Final rules, Summary and section III)
  • Findability. Plans must post a text file with contact information for their files, and a website footer with links. (Final rules, Summary)

Points raised in comments

Commenters generally supported quarterly reporting and standardization. One commenter warned that without enforcement tied to update frequency, “the quarterly cadence risks allowing widespread noncompliance to persist.” The Departments said any harm from a lag in data “would be outweighed by the significant burden reduction.” (Final rules, comments and responses)

Who it affects

People with job-based or individual health insurance in non-grandfathered plans, and the employers and insurers that offer them. The phone requirement also reaches grandfathered plans through the No Surprises Act. (Final rules, Summary)

What it means for you

Starting with plan years that begin on or after January 1, 2027, you can call your plan and get an estimate of your out-of-pocket cost for a service at specific providers. The phone number should be on your insurance card, as the No Surprises Act requires. (Final rules)

Current status

Published October 6, 2026; effective December 7, 2026. (Final rules, “Dates”)

Sources

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Every statement above is drawn from the official source text linked here; section references are shown in grey. This is a plain-English summary, not legal advice. Spot an error? Tell us.