Premium Transparency Act
Sponsored By: Representative Pfluger, August [R-TX-11]
In Committee
Summary
Insurer financial transparency. The Premium Transparency Act would require health insurers and Medicare Advantage organizations to publish clear, plan-level breakdowns of how premium dollars are spent. It would also require standardized, plain-English displays of key plan features to make shopping and year-to-year comparisons easier.
Show full summary
- Families and consumers would get consumer-friendly data showing the share of premiums spent on claims, non-claims costs, and what insurers retain. They would see standardized info on monthly premiums, deductibles, out-of-pocket limits, network type, and typical in-network cost-sharing.
- Medicare Advantage enrollees would see MA plan-level reporting of total revenue, amounts and percentages spent on incurred claims and non-claims costs, and the MLR gap. Those MA disclosures would apply for plan years on or after January 1, 2027.
- Exchange shoppers would get the most recent plan-level transparency data for plans offered in previous years to improve year-to-year comparability. This change takes effect for plan years on or after January 1, 2029.
- Issuers and Medicare Advantage organizations would submit the required data to the Department of Health and Human Services and publish it on their public websites, and follow HHS guidance on a standardized plain-English presentation by January 1, 2028.
*Would increase public visibility into insurer overhead and claims spending and create standardized plan summaries to help consumers compare coverage.*
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Health insurer premium transparency
This bill would require health insurers to publish how they spend premium dollars starting with plan years beginning January 1, 2027. Issuers would submit and post, at the coverage level, the percent of total premium spent on the listed categories, the required explanation of those categories, and the percent of premium the issuer retains. The Secretary could let issuers aggregate similar coverages across a market. If enacted, Exchange websites would add the issuer-submitted numbers to plan comparison displays for plans that were offered in a prior year starting for plan years beginning January 1, 2029.
Medicare Advantage plan spending reports
This bill would require Medicare Advantage organizations to submit and publish plan-level financial data for plan years beginning January 1, 2027. Each MA plan would post total revenue, dollars and percent spent on incurred claims, dollars and percent spent on non-claims costs, the MLR numerator-minus-denominator gap in dollars, and that gap as a percent of revenue. Data must be on each MA plan’s public website unless the Secretary permits aggregation. This would give beneficiaries and advisors clearer numbers about how plans spend revenue but would not change benefits or payments.
Plain-language plan information rules
This bill would require HHS to issue plain-English guidance by January 1, 2028 for group plans, issuers of group or individual coverage, and Medicare Advantage organizations. The guidance would standardize how plans present monthly premium, annual deductible, maximum out-of-pocket, provider network type, plan share of allowed costs, and standard in-network cost-sharing for common services (for example primary care, specialist, urgent care, emergency, imaging, inpatient and outpatient facility care, laboratory services, and drugs). It would also cover other features like referral rules, wellness and disease management programs, HSA eligibility under section 223 of the Internal Revenue Code, and preventive care coverage. The Secretary must consult Labor and Treasury, and the guidance would not force plans to add benefits.
Sponsors & CoSponsors
Sponsor
Pfluger, August [R-TX-11]
TX • R
Cosponsors
Rep. Moran, Nathaniel [R-TX-1]
TX • R
Sponsored 6/23/2026
Roll Call Votes
No roll call votes available for this bill.
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