Consumers should have access to personalized, actionable information to make better, more informed decisions before they seek and receive care. Health insurance provider tools are best positioned to provide them with that access.
Cost estimator tools give consumers estimated costs for covered items and services before seeking care. But generalized price transparency information, such as information provided by state databases, or cost estimates derived through a third party, cannot provide personalized information in real time about an enrollee鈥檚 actual expected out-of-pocket costs. For example, these tools do not provide information such as where an enrollee stands in their deductible for the year.
Health insurance provider tools include information specific to an individual enrollee鈥檚 coverage, including their benefits, provider network, progress toward a deductible or out-ofpocket maximum, progress toward other limits, and flag any applicable medical management tools such as the need for prior authorization for a specific service. Some tools use technology and data analytics to provide a more nuanced, personal estimate such as information like an individual provider鈥檚 billing practices or an individual enrollee鈥檚 age, health, or other conditions.
Key Takeaways
- In 2021, nearly all commercial health insurance providers made price transparency tools available to their enrollees, with cost estimates available for a median of about 700 different health care services. Beginning in January 2023, federal regulations will require health insurance providers to offer all enrollees in commercial health insurance access to a comprehensive online tool to estimate health care costs.
- Cost estimator tools estimate costs of complex medical services and procedures, including elective outpatient surgery/procedures, inpatient surgical services, inpatient non-surgical services, physician services, outpatient laboratory services, radiology services, prenatal care, and delivery and postpartum care.
- While nearly half of enrollees (48%) have created credentials to log-in to the member portal, website, or app where the cost estimator tool can be accessed, health insurance providers continue to work to increase awareness and utilization of these essential consumer tools.