People with multiple private health insurance plans in the United States will have a new way to know how much they might pay out of pocket before a consultation, a diagnostic test, or a covered treatment. The plans and insurers subject to the new federal rules will be required to provide personalized cost estimates over the phone, upon request from the member, for coverage years starting on January 1, 2027.
The obligation is part of the final rule Transparency in Coverage (CMS-9882-F), announced on October 5, 2026, by the Centers for Medicare and Medicaid Services (CMS), along with the Departments of Labor and the Treasury, and published the following day in the Federal Register.
According to the official CMS explanation, the measure aims to improve access to information regarding shared expenses between insurance and the patient. It does not equate to guaranteeing the final price of a medical bill in advance, as this may vary depending on the care actually received and the conditions of the policy.
The estimate can be requested by calling the number on the insurance card
One of the main updates is that the cost information that numerous plans are already required to provide online or on paper, when requested, must also be available by phone.
The regulation states that the request will be handled through the customer service number listed on the physical or digital insurance card. The information provided must be correct at the time of the inquiry and should be provided accordingly, in compliance with the requirements of the regulation.
This change may especially benefit those who have difficulty navigating digital tools or wish to speak with a representative before choosing a doctor, hospital, or scheduled service.
The requirement is added to the electronic transparency mechanisms implemented since the federal regulations of 2020. This does not mean that telephone consultations were prohibited until now: some companies already offered them, but the new provision establishes explicit requirements for the plans it covers.
What information can be consulted before a medical visit?
The information that should be provided by phone pertains to shared expenses that are already part of the federal estimation tools. Depending on the coverage and the service requested, they may include the estimated amount charged to the insured, the application of their deductible, and the terms of copayment or coinsurance.
For example, someone who needs an MRI could request an estimate of their out-of-pocket expenses for the procedure covered at a specific center and, when applicable, compare the information with that of another provider.
For that comparison to be useful, the patient should identify the service and provider as accurately as possible. It is also advisable to ask whether the doctor and the facility are part of the insurance network, whether prior authorization exists, and if other professionals might bill separately.
The regulation also provides for the possibility of consulting various providers via telephone service. If a plan decides to set a daily limit on the number of providers for which it provides information, that limit cannot be less than 20 providers per operational day. The company must inform the applicant of the applicable limit.
This does not mean that the patient is obligated to compare 20 centers or that all consultations must be resolved with a single call: it is the minimum limit that an insurer can set if it chooses to restrict the number of providers available for consultation in a day.
Which health insurance plans will be subject to the new rules?
The transparency provisions primarily target collective health plans and insurers that offer individual or collective coverage subject to federal regulations. This includes numerous policies related to employment and private insurance purchased in the individual market.
The regulation also coordinates the requirements for phone price consultations with the obligations established in the federal No Surprises Act, including certain coverages classified as pre-existing before healthcare reform (grandfathered plans) that are not subject to all the technical data publication requirements.
It should not be interpreted, however, that these same provisions automatically modify the rules of traditional Medicare or Medicaid, which are administered under different systems and regulations.
For those preparing to purchase or renew an individual policy, CiberCuba recently explained what documents and conditions to review before enrolling in Obamacare for 2027.
When does the obligation to report by phone begin?
The federal regulation was published on October 6, 2026, and its general effective date is December 7, 2026. However, this does not mean that all obligations must be applied from December.
The new provisions of the consumer information tool, including the telephone modality, will apply to the plan or policy years that begin on January 1, 2027, or later. Therefore, the exact date will depend on the start of the corresponding coverage year.
There are other deadlines for the public price files that insurers must make available to consumers, researchers, and developers. Certain technical changes will begin to take effect on March 6, 2027, and various additional obligations for contextual data and file location will take effect on September 6, 2027.
It is important not to confuse those calendars with the application date for the telephone service estimates for affiliates. The different deadlines are outlined in the rule published in the Federal Register.
The estimate does not guarantee how much the treatment will ultimately cost
Knowing the estimated out-of-pocket expenses can help compare options and plan for medical payments, but the figure is not necessarily definitive.
The actual disbursement may depend on the services provided, which professionals are involved, whether they all belong to the network covered by the policy, and how much remains to be covered from the deductible. Therefore, the patient should review the warnings that accompany the price information and the specific conditions of their contract.
In certain cases, there may be other federal protections against unexpected medical bills, but it is not correct to interpret that the phone estimate replaces those regulations or that it eliminates any differences between a prior calculation and the final bill.
What should you ask the health insurance before a procedure?
To make better use of the comparison tools, a patient who needs to undergo non-urgent care can prepare the following questions:
- What would my estimated out-of-pocket expense be for the procedure or consultation?
- Does the doctor and the care center belong to my policy’s network?
- How much do I still need to pay to reach my deductible?
- What copayment or coinsurance percentage applies?
- Is prior authorization required to receive the service?
- Could professionals who bill for their services separately get involved?
- Can I obtain the information in writing or through the digital tool of my plan?
Although the new telephone obligation has a later implementation deadline, insured individuals can already use the cost information tools currently provided by their plan and compare them with the data provided by the hospital or clinic.
A different measure from the recent warnings from the FTC
The new CMS regulation was announced on the same day the Federal Trade Commission (FTC) warned 24 major healthcare companies about potential transparency issues in price presentation.
As CiberCuba reported, that action by the FTC focused on the risk that a figure announced as the price of a procedure excludes important charges, such as medical fees or facility fees.
They are different initiatives: the FTC warned about possible misleading business practices, while the federal departments responsible for the CMS-9882-F regulation approved specific obligations to facilitate and improve information on medical insurance prices.
For many residents of Florida, including Cubans with coverage obtained through employment or the individual market, the main update will be the ability to request a phone estimate of how much they would need to pay for a covered service and use that information to compare options before receiving scheduled care.
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