Healthcare (Medicare · 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 Medicare Advantage Cost Transparency Act requires Medicare Advantage plans to include specific cost details in their data submissions starting in 2027. This change mandates that records show the allowed amount for services and the exact cost-sharing amounts, such as deductibles and copayments, that patients must pay. Additionally, the bill requires plans to note whether a patient received an at-home health risk assessment from a company related to the plan or from an independent provider. The primary goal is to increase financial clarity for individuals enrolled in Medicare Advantage plans by making billing information more transparent.

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.

The Drug Deal Disclosure Act requires the Department of Health and Human Services to publicly release specific records regarding agreements between the federal government and major drug manufacturers starting in 2025. This law mandates the disclosure of contracts that include provisions such as reduced drug prices based on international rates, direct-to-consumer sales discounts, duty exemptions, and special treatment for Medicare programs. While the bill allows for the redaction of confidential pricing details, it prohibits withholding information based on political sensitivity or reputational harm and requires a detailed justification for any redactions. Additionally, the act mandates reports to Congress and independent analysis from the Congressional Budget Office and the Government Accountability Office to evaluate the economic and budgetary impacts of these agreements.