Last month, the Centers for Medicare & Medicaid Services (CMS) released its Transparency in Coverage final rule. This rule intends to improve price transparency for patients and simplify the comparison and selection of health plans and services. It goes into effect on December 7, 2026.

1 – Information on rates (prices) for health care services will be easier to access

Starting in 2020, it was established that most health insurers had to post machine-readable files disclosing in- and out-of-network rates (prices) for covered services. The Transparency in Coverage rule modifies this requirement, directing plans to post simplified rate files that remove unlikely provider-rate combinations (such as a provider-negotiated rate for a podiatrist to perform an appendectomy). A new file, listing providers’ actual reimbursements for services provided to patients in the most recent policy year, must also be posted.

Information on rates for health care services are currently posted by specific health insurance plan, but this rule changes postings to include all rates for an overall provider network. It is still mandatory to identify specific plans that use a given provider network, however, since many insurers use a similar network for all their plans, this level of organization will reduce both file number and size, making the information easier to navigate.

To further improve access to these machine-readable files, the final rule requires plans to publish a plain text file that details the exact location of the machine-readable files and contact information for any related inquiries. A plan must also have a clearly labeled, direct link to these files on its website.

2 – Codes that identify provider types will be published, increasing billing transparency

Plans are also required to post provider taxonomy code maps, which identify the type of medicine a provider practices, along with a more specific classification and specialty. Taxonomy codes are used to streamline medical billing by more easily identifying services provided, so publicizing these codes further increases the level of transparency for patients when viewing medical bills.

3 – Patients should be aware that some rates will be posted as percents, not dollar amounts

Despite these efforts to increase transparency, patients should be aware of a loophole in the final rule that could make some of its provisions less transparent. Though most in-network rates must be posted as dollar amounts, plans that pay contracted providers a “percentage-of-billed-charges” are allowed to post in-network rates as percentages. Without an attached dollar amount, these percentages are not useful to patients and lack the transparency intended by this rule.

4 – Data collection practices will be changed, allowing for more available information

The Transparency in Coverage final rule also includes provisions aimed at increasing the amount of data included in out-of-network allowed amount files (files that indicate the maximum amount a plan will pay for a given service received out-of-network). The rule lowers the reporting threshold for out-of-network allowed amounts from 20 claims to 11, expands the reporting period, and requires insurers to aggregate files at the market level. These changes allow information to be reported sooner and in larger quantities, creating a larger database that researchers can use to understand out-of-network allowed amounts and inform patients accordingly.

5 – Health plan executives are required to attest that posted rate files are accurate

The rule also requires Senior officials, such presidents and COOs of the plan issuers, to attest to the completeness and accuracy of all posted rate files. This provision was recommended by consumer advocates and adds a layer of increased accountability to the CMS final rule.

Overall, these provisions aim to increase patient access to and understanding of information on prices for a given insurance plan. Changes to data collection rules will hopefully lead to more knowledge on out-of-network rates, and further aid consumers in making choices that are the best fit for their health.