CMS has issued its final rule mandating that all nearly all health insurers and self-insured plans disclose pricing and cost-sharing information. The Transparency in Coverage Act requires them to post in-network and out-of-network rates they negotiate with providers. It also requires insurers to develop online price transparency tools to give patients cost-sharing information. Insurers and hospital groups and even some experts argued it would confuse patients and do little to lower costs. Payers will have to make available a list of 500 shoppable services through an online tool by Jan. 1, 2023. (Modern Healthcare
*; CMS fact sheet
What does Biden’s victory mean for the Affordable Care Act? Much depends on who controls the Senate, but a Health Affairs Blog post offers some “tentative” insights. A Biden administration could announce an immediate special enrollment period and increase outreach to spread the word that coverage is available. This would benefit the newly uninsured who may be unfamiliar how Marketplace enrollment works. It could reverse other Trump era changes through rulemaking, although that would take time. Unilateral options include providing temporary relief from premium tax credit reconciliation requirements and promoting standardized plans. (Health Affairs
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