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Health and Human Services Secretary Robert F. Kennedy Jr. said something on Oct. 5 that almost nobody could argue with.
“Americans should know what their healthcare will cost before they receive it,” Kennedy said as the administration announced new price-transparency rules. (1)
Dr. Mehmet Oz, who runs the Centers for Medicare & Medicaid Services, went further: “People should know what their health insurance will cover and what they will need to pay before receiving medical care, not after the bill arrives.” (1)
I’ve been a CPA since 1981, and I agree with both of them. But retirees should read the fine print.
The new rules are aimed at group health plans and health insurance companies. Among other things, they’ll have to give you personalized cost-sharing information by phone, in addition to their online tools. (1)
A new prescription drug price file isn’t expected until December 2027. (1)
Meanwhile, if you’re on Original Medicare, you already face a $283 Part B deductible in 2026, and after that you usually pay 20% of the cost of each covered service. (2)
The good news: you don’t have to wait for Washington. Hospitals have had to post prices since Jan. 1, 2021. (3) And if you’re uninsured or choose not to use your insurance, you generally have a right to a good faith estimate. (4)
Here are five ways to find the price before the bill.
1. Under 65 with job-based or private coverage? Call your insurer first
If you’re under 65 and covered through an employer’s group plan or a policy from an insurance company, these rules are aimed at plans like yours. (1)
Before a planned procedure, call the number on your card and ask what you’ll owe in your plan, at that provider, for that service. Write down the answer, the date and the name of the person you spoke with.
My read: that note won’t guarantee the price. But it gives you something concrete to point to if the bill comes in far higher.
2. Look up the hospital’s posted price, including the cash price
Since Jan. 1, 2021, hospitals have had to make their standard charges public, including the rates they negotiate with insurers and the discounted price they’ll accept if you pay cash. (3)
They must post standard charges for at least 300 “shoppable” services that can be planned in advance. (3)
Check two or three hospitals near you. For a scan, a colonoscopy or a minor surgery, the gap between them can be worth a phone call.
3. On Medicare? Compare the hospital to a surgery center
Medicare has its own free tool. Its Procedure Price Lookup, launched in 2018, lets you compare Medicare payments and copayments for certain procedures done in both hospital outpatient departments and ambulatory surgical centers. (5)
It shows national averages, including the average copayment for someone with no Medicare supplemental insurance. (5) So treat it as a starting point, not a quote, and ask the facility for its numbers.
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4. Paying cash? Demand a good faith estimate
If you don’t have insurance, or you choose not to use it, the No Surprises Act generally gives you a right to a good faith estimate: a list of expected charges before you get care. (4)
You’re eligible if you schedule care at least three business days in advance, and you can also ask for one. (4)
And here’s a part that’s easy to miss. If a provider’s bill comes in at least $400 more than its good faith estimate, you can dispute it. You have to start the dispute within 120 days of getting your first bill. (4)
5. Don’t wait until 2027 to shop for prescriptions
The drug-price file in the new rules isn’t expected until December 2027. (1) Your prescriptions cost money now.
Ask your pharmacist for the cash price as well as your copay, and compare a couple of pharmacies. Discount programs can help, too.
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My honest take
Kennedy and Oz are right. You’d never buy a car, a house or a dishwasher without knowing the price first. Health care shouldn’t be different.
But these rules won’t fix your bill by themselves, and my read is that much of their impact lands on people who aren’t on Medicare.
So use the tools you already have. Call before, ask for it in writing, compare, and dispute when you’re overcharged. The most expensive medical bill is the one you never questioned.
Sources: 1. Centers for Medicare & Medicaid Services; 2. Medicare.gov; 3. Centers for Medicare & Medicaid Services; 4. Centers for Medicare & Medicaid Services; 5. Centers for Medicare & Medicaid Services
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