Group health plans and insurers will have to give members personalized cost-sharing estimates over the phone, not just online or on paper, for plan years that begin on or after January 1, 2027. The requirement is part of final Transparency in Coverage rules that the Department of Health and Human Services announced October 5, 2026, together with the Labor and Treasury departments. The rules were published in the Federal Register the next day and take effect December 7. HHS Secretary Robert F. Kennedy, Jr. said in the announcement, “Americans should know what their healthcare will cost before they receive it.”
For anyone with job-based coverage or an individual plan, the change comes down to one phone call. A member who asks the insurer what a procedure, test or visit will cost under the plan can no longer be told that the estimate lives only on a website. The first plan years covered start January 1, 2027, so a member whose plan year begins that day gets the phone option from the first week of the year, while plans with other start dates reach it later.
The rule takes effect December 7, 2026, and the first plan years it covers begin January 1, 2027, which is when the phone estimates start.
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How the phone estimate is meant to work
The Federal Register notice, published October 6 at 91 FR 63748, says plans and insurers must provide by phone, when a member asks, the same pricing information they already offer through an online tool or on paper. The information has to be accurate at the time of the request. A plan may use the customer service number printed on the member ID card, and the duty stays with the plan or insurer even when an outside company answers the calls.
The rule leaves out several details. It sets no list of services that must be covered on a call, no wait-time standard and no required hours beyond a plan’s existing customer service. A plan may cap phone requests at 20 providers per operational day, and if it does, it must tell the caller about the limit. The phone option rests on 2020 rules that required an internet tool or, on request, paper, so the new rule adds a third route to something plans were already doing.
According to the CMS fact sheet, the amendments to the internet-based self-service tool apply for plan years, or policy years in the individual market, beginning on or after January 1, 2027. The rules cover non-grandfathered group plans and insurers that sell non-grandfathered group or individual coverage. Grandfathered plans are not subject to the new file requirements, although giving the information by phone, online or on paper also satisfies section 114 of the No Surprises Act for grandfathered plans not otherwise covered.
Price files move to quarterly updates
Behind the phone line sit the machine-readable price files that plans post for researchers, employers and software companies. The final rules shift the in-network rate file and the out-of-network allowed-amount file from monthly to quarterly updates, according to the CMS fact sheet. HHS says the change keeps transparency meaningful while lowering administrative burden. In practical terms, a file that refreshed 12 times a year will refresh four, so a rate change can sit for up to a quarter before it shows up.
Other changes are aimed at making the files usable. The reporting threshold for out-of-network allowed amounts drops from 20 claims to 11. Plans must replace per-plan in-network rate files with one file per provider network, add product type and network name, and attest that the data is accurate and complete. They must also add a taxonomy file, a utilization file, a plain text file with a monitored contact email, and a “Price Transparency” or “Transparency in Coverage” link in the website footer. The in-network and out-of-network amendments apply five months after publication, and the taxonomy, utilization and text file amendments apply 11 months after.
Drug prices come later. The HHS announcement says the departments plan to begin developing the schema for prescription drug files in November 2026 and finalize it around May 2027. Plans and insurers would then publish those files starting in December 2027, and monthly after that. The CMS fact sheet sets no new date for the drug file, so December 2027 comes from the HHS release alone.
What officials claim for the rules, and what the numbers cover
The HHS release credits President Donald Trump with directing the effort, and the rule cites Executive Order 14221, issued February 25, 2025, titled “Making America Healthy Again by Empowering Patients With Clear, Accurate, and Actionable Healthcare Pricing Information.” CMS Administrator Dr. Mehmet Oz said, “Greater transparency drives competition, reduces price disparities, and helps lower healthcare costs.” Labor Secretary Keith Sonderling said the rules “will enhance the Transparency in Coverage (TiC) files already in existence.”
The only dollar figure comes from the CMS fact sheet, and it is not a consumer saving. The departments expect the rules to produce a net cost savings to plans and insurers of approximately $174.5 million a year, starting in the second year of implementation. The HHS release gives no estimate of what patients would save. It does say that the top 25 percent of the most expensive healthcare service prices have dropped by 6.3 percent per year since transparency requirements began, citing “recent data” without naming a source or tying the drop to this rule.
Asking a plan for an estimate
The first stop is the member services number on the back of the insurance card, which the rule names as an acceptable line for estimates. Before January 1, 2027, or before the first plan year that begins after that date, plans are not required to offer the phone option, so a member who calls earlier may still be pointed to a website. After the start date, a refusal to give an estimate by phone would be a problem to raise with the plan.
Estimates reflect the plan’s own cost-sharing, such as deductibles and copays, which is why the call matters more than a posted price list. A caller asking about several providers in a day should expect the 20-provider cap to matter only for unusually long lists, and the plan must say so if it applies one. The rule does not say how quickly an answer must arrive, so a call may still end with a callback.
What to watch is whether plans staff the line before the first plan years begin. The Federal Register notice makes the rule effective December 7, 2026, and the phone duty attaches to plan years starting on or after January 1, 2027, with the drug files still a year off. The $174.5 million figure measures industry costs, not what a member will pay, and HHS has put no dollar estimate on patient savings.
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This article was produced with AI assistance and reviewed by The Money Overview’s editorial team.
