This bill, the Premium Transparency Act, requires health insurance issuers and Medicare Advantage (MA) organizations to submit and publish detailed information about premiums, claims, and overhead. For plan years beginning on or after January 1, 2027, group and individual issuers must submit to HHS (and to an Exchange if sold there) and publish on their public website: the share of premium revenue spent on categories already required under current law, the explanatory text required by current law, and the percentage of premium revenue retained by the issuer. The Secretary may also require aggregate publication across an issuer's offerings.
For Medicare Advantage, starting with plan years on or after January 1, 2027, MA organizations must submit and publish for each MA plan: total revenue collected, amounts and percentages spent on incurred claims and on non-claims costs, and the difference between the MLR numerator and denominator expressed as an amount and as a percentage.
The bill also amends Exchange plan comparison tools so that for enrollments in plan years beginning on or after January 1, 2029, Exchanges include the most recent information submitted by issuers under the new reporting requirement for plans that were offered the previous year.
Additionally, the Secretary of Health and Human Services must issue guidance by January 1, 2028, telling plans and issuers how to provide benefits and coverage information in a standardized, plain-English format. That guidance must cover items such as monthly premiums, annual deductibles, out-of-pocket limits, network type, the plan's share of allowed costs, standard in-network cost-sharing for specific services (primary care, specialist care, urgent care, emergency care, imaging, inpatient and outpatient facility care, lab services, preferred brand and generic drugs), and other plan features (referral rules, wellness programs, disease management, HSA eligibility, preventive care). The Secretary will consult with the Secretaries of Labor and the Treasury when making the guidance. The guidance does not force plans to offer any specific features.
If you shop for or enroll in private health coverage or a Medicare Advantage plan, issuers and MA organizations must post clear information about how premium dollars are spent and how much is retained. Exchanges must include that reported information in their plan comparison tools for future plan years. The Department of Health and Human Services will issue plain-English standards to make plan benefits and costs easier to compare.
No publicly available information.
The bill is described as a measure "to ensure health insurer accountability through publishing of overhead costs and claim payments" and to improve comparability of plans by requiring disclosure and standardized, plain-English information.
No publicly available information.