Premium Transparency Act

Key Points

• Starting in 2027, health insurance companies must publicly disclose how they spend your premium dollars, including what percentage goes to medical care, overhead costs, and profit they keep. This applies to individual plans, employer plans, and Medicare Advantage.
• Medicare Advantage organizations must also disclose detailed financial breakdowns for each plan, including total revenue collected, the amount spent on actual medical claims, and the amount spent on non-claims costs like administration and marketing.
• By 2029, HealthCare.gov and state marketplace websites must display this spending data alongside plan options so shoppers can compare how much of their premiums different insurers actually spend on healthcare.
• By January 2028, HHS must issue guidance requiring insurers to present plan details like premiums, deductibles, copays, and covered services in a standardized, plain English format so consumers can more easily compare their options.