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Your Rights and Protections
Overview of new protections and price transparency requirements and tools
Have you been in this situation?

You get medical care. Then you receive a bill that’s higher than you expected.
  • Maybe it’s because you didn’t realize that one of your providers was out-of-network. Because of that, you were charged more than the plan’s allowable charge. That’s known as “balance billing” or “surprise billing.”
  • Maybe the provider just charged more than you realized they would.
  • Maybe you didn’t fully understand how your health care plan determines your out-of-pocket cost.

It’s frustrating. It can also be frightening if you can’t afford to pay the bill.

But federal rules protect you, the health care consumer, from certain surprise bills. Other federal rules require disclosure of health care pricing practices and ensure you have access to tools to compare your potential out-of-pocket costs for services before you receive care. These new rules will help you avoid surprise billing and give you better visibility into what you’ll pay out of pocket for health care before you receive services.

Snapshot of new protections you will have and when they take effect


Consumer Protections and Transparency Rules*
Effective Date
Hospitals must disclose prices for common services negotiated with each health care plan
January 1, 2021
You’re protected from surprise billing on certain out-of-network medical services
January 1, 2022**
You’re protected if your provider leaves the network: if you are receiving care for a complex condition or pregnancy and your in-network doctor leaves the network, you can receive care from that provider at an in-network level for 90 days
January 1, 2022
Your health insurance ID cards begin to show more information about your plan’s deductibles and annual out-of-pocket limits
January 1, 2022
Plans must issue updated provider directories every 90 days
January 1, 2022
Your health care plan must provide a price comparison tool and permit you to request estimated out-of-pocket costs for various services (500 shoppable services)
January 1, 2023
Your health care plan must provide a price comparison tool and permit you to request estimated out-of-pocket costs for all services
January 1, 2024**


*This represents some of the major protections that impact individual health care consumers; it is not an exhaustive summary of all the regulations.
**For calendar-year plans.
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