Healthcare (Insurance · Government Transparency)

The Health Insurance Transparency for Patients Act requires health insurance companies and Medicare Advantage organizations to publicly report detailed data on how they handle coverage requests. Starting with plan years after the law is passed, these providers must annually submit and display online information about the number and percentage of claims denied versus approved, along with the specific reasons for denials. The report must also break down data by the review method used, such as automated systems or human reviewers, and include the time it took to reach a decision. Additionally, the bill mandates that these organizations list all services requiring prior authorization and publish this information in a simple, easy-to-understand format. The Department of Health and Human Services will also make this data available on its own website to ensure public access.

The Premium Transparency Act requires health insurers and Medicare Advantage organizations to publicly disclose how they spend premium revenue, specifically detailing the percentages allocated to claims, overhead costs, and retained profits. Starting in 2027, these companies must publish this data in a consumer-friendly format on their websites for each plan they offer, allowing individuals to compare financial transparency across different coverage options. Additionally, the bill mandates that the government issue standardized guidance by 2028 to ensure key plan details, such as deductibles, out-of-pocket limits, and specific care costs, are presented in plain English. A further provision updates online plan comparisons to include this new financial data beginning in 2029, aiming to help consumers make more informed decisions about their health insurance.