Inefficacy of the Transparency in Coverage Final Rule in Promoting Cost-Effective Choices

Authors

Abigail Jaeger

Document Type

Student Comment

Abstract

The Transparency in Coverage Final Rule requires health plans to provide beneficiaries with financial information such as estimates of their personalized cost-sharing liabilities for items and services offered by different providers, the plan’s negotiated in-network rates with these providers, and the plan’s allowed out-of-network amounts. The Final Rule is designed to enhance consumers’ access to pricing information under their health plan so they have the ability to make well-informed and cost-effective decisions regarding their health care. However, empirical evidence suggests that the Final Rule will not effectuate its intended purpose. Many consumers lack the high level of health insurance comprehension required to interpret and understand this information, and an overabundance of technical information provided to consumers overcrowds their decision environment, resulting in consumers feeling overwhelmed with their choice set. Together, a lack of health insurance comprehension and an overcrowded decision environment lead to information overload among consumers, preventing them from using this financial information to make cost-effective health care choices. To carry out the Final Rule’s intended purpose, the rule should be interpreted to require health plans to format this pricing information using symbolic designations and standardized graphics as well as to provide personalized assistance to consumers upon disclosure. This formatting and personalized assistance will mitigate the effects of information overload and empower consumers to use this financial information to make cost-conscious health care decisions.

Recommended Citation

Abigail Jaeger, Inefficacy of the Transparency in Coverage Final Rule in Promoting Cost-Effective Choices, 16 St. Louis U. J. Health L. & Pol'y (2023).
Available at: https://scholarship.law.slu.edu/jhlp/vol16/iss2/6