How much does an MRI cost? For most Americans, the honest answer has long been "it depends," and finding out in advance has been nearly impossible. Since 2022, federal rules have required most health insurers and employer health plans to publish the prices they have negotiated with doctors and hospitals. But the resulting data files have been so enormous and messy that even researchers have struggled to use them. On October 5, 2026, the federal government finalized changes intended to fix that.
What was finalized
The Centers for Medicare & Medicaid Services (CMS), together with the Departments of Labor and the Treasury, finalized updates to the Transparency in Coverage rules, which were first adopted in 2020 during President Trump's first term [1][4]. The new rules apply to most private health insurers and employer plans, specifically non-grandfathered group plans and individual-market insurers, and they take effect December 7, 2026 [6][2]. The changes follow a February 2025 executive order directing federal agencies to strengthen price transparency enforcement [1][5]. "Americans should know what their healthcare will cost before they receive it," Health and Human Services Secretary Robert F. Kennedy Jr. said. "These rules give patients clearer, more reliable information to compare costs, understand their coverage, and make informed decisions before they receive care" [3].
Getting rid of "ghost rates"
The best-known problem with the existing data is what researchers call "ghost rates": negotiated prices that appear in insurers' files for services a provider never actually performs. A cardiologist, for example, might appear in a file with a negotiated rate for childbirth. Because insurers often list every rate in a broad contract, the files can swell with prices that will never be used. In March 2026, Georgetown University researchers found that 91.8% of the rates listed in transparency files across 61 insurers were ghost rates [2]. Under the final rule, insurers must remove these rates. They can decide which rates to drop using their own internal rules, but they must publish those rules in a new file so outsiders can see how the decisions were made [2].
Other key changes
The rule makes several other changes to how the data are organized and found [2][3][4][5]: • Rates will be organized by provider network rather than by individual plan, which is intended to cut down on duplicate data.
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According to the American Journal of Managed Care, insurers will post the main pricing files quarterly rather than monthly.
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Plans must use a single file format, post a plain text file on their website showing where the files are located, include a monitored contact email and add a "Price Transparency" or "Transparency in Coverage" link to their homepage.
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Each file must include an attestation that the data are accurate and complete, along with the name of a senior executive, such as the plan's CEO or president, who oversees it. This mirrors a requirement CMS began enforcing for hospitals in April.
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Disclosures about payments for out-of-network care are expanded.
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Insurers and plans must also offer personalized cost estimates by phone, not just through online tools. The government declined to require consumer-friendly cost summaries within the files themselves, saying the data cannot reflect an individual patient's deductible or other cost-sharing [4].
Reactions
The changes drew support from groups that do not always agree. The American Hospital Association (AHA), which represents hospitals that have faced their own price transparency requirements since 2021, welcomed the rule. "Hospitals have spent years making detailed pricing information public, and we welcome efforts to bring greater transparency to health plan data," said Ashley Thompson, AHA senior vice president [7]. Large employers, who pay for health coverage for millions of workers, also praised the changes. "This rule makes the data usable by a general audience," said James Gelfand, president and CEO of the ERISA Industry Committee, which represents large employers. The group said better data would help employers compare provider prices, negotiate costs and make decisions about their networks [5]. Some researchers have cautioned that the rules still have gaps. A researcher quoted by the American Journal of Managed Care noted that ghost rates and missing inpatient data had limited the usefulness of the files, and that how well insurers comply will determine whether the changes succeed [3]. Enforcement has also been a recurring concern. For hospitals, CMS has fined 28 facilities for violating price transparency rules [4]. In the new rule, the government said it would prioritize enforcement and work to make enforcement actions public [4].
Hospitals versus insurers
The insurer rule is separate from, but closely related to, federal hospital price transparency rules, which have required hospitals to post their prices since 2021. As of this year, hospitals must publish actual dollar amounts for services rather than estimates [4]. Comparing hospital files with insurer files is one of the main ways researchers check whether published prices are accurate, which is why both hospitals and insurers have pushed for the other side's data to be cleaner. The Federal Trade Commission has also become involved: around the time the rule was announced, FTC Chairman Andrew Ferguson issued a warning to major for-profit hospital groups about their legal obligation to provide truthful pricing [8].
Who uses this data
Although the rules are often described as helping patients shop for care, most individuals will not read machine-readable files directly. The data are used mainly by employers, researchers, journalists, technology companies that build price comparison tools and competing health care providers. Surgery centers, for example, may use the files to see what insurers pay their competitors before negotiating their own contracts [2]. In that sense, the policy's main goal is to expose price differences that have long been hidden and let market pressure do the rest.
Why it matters
Price transparency is one of the few health policy goals with support across party lines. The first rules, adopted under President Trump in 2019 and 2020, were kept and enforced under President Biden, and this update builds on them. The central question has never been whether prices should be public, but whether the published information is accurate and usable enough to change behavior. The December rules are the government's latest attempt to answer that question with better data.
Sources
- 1. "New Regulations Make It Easier to Find, Compare, and Report Healthcare Pricing and Coverage Information," HHS/CMS press release, October 5, 2026. https://www.hhs.gov/press-room/cms-finalizes-healthcare-price-transparency-rules.html
- 2. "What CMS' price transparency overhaul means for ASCs," Becker's ASC Review, October 2026. https://ww w.beckersasc.com/asc-coding-billing-and-collections/what-cms-price-transparency-overhaul-means-for-ascs /
- 3. "CMS Moves TIC Reporting to Quarterly, Sets Drug File Timeline," American Journal of Managed Care, October 6, 2026. https://www.ajmc.com/view/cms-moves-tic-reporting-to-quarterly-sets-drug-file-timeline
- 4. "CMS finalizes price transparency overhaul for payers: 6 things to know," Becker's Hospital Review, October 2026. https://www.beckershospitalreview.com/finance/cms-finalizes-price-transparency-overhaul-f or-payers-6-things-to-know/
- 5. Eve Bender, "CMS overhauls insurer price transparency rules," Healthcare Finance News, October 2026. https://www.healthcarefinancenews.com/news/cms-overhauls-insurer-price-transparency-rules
- 6. "Transparency in Coverage" (final rule summary), Rural Health Information Hub, October 6, 2026. https://www.ruralhealthinfo.org/news/39062
- 7. American Hospital Association, statement on Transparency in Coverage final rule, October 2026. https://www.aha.org/node/711898
- 8. "WATCH: Trump administration issues final rule on transparency in healthcare coverage," Associated Press via PBS NewsHour, October 5, 2026. https://www.pbs.org/newshour/health/watch-trump-administration-is sues-final-rule-on-transparency-in-healthcare-coverage Information in this article is current as of October 9, 2026. Bracketed numbers refer to the sources listed above.