Premium Transparency Act (H.R. 9397)

Summary

Makes health insurance companies show how they use money from premiums, including what they spend on medical care, other costs, and what they keep as profit.

What problem does this solve?

People often do not know how their health insurance premiums are used by the insurance company. This bill forces insurers to publish detailed reports on their spending so customers can see where their money goes.

What does this bill do?

Requires public reporting for health insurers

Forces health insurance companies to publish a yearly report on their website showing how they spent premium money on medical claims, quality improvements, and other costs, starting in 2027.

Adds transparency for Medicare Advantage plans

Requires Medicare Advantage plans to submit and publish detailed financial information each year, including total revenue, money spent on claims, and non-claim costs, starting in 2027.

Standardizes plan information

Directs the Secretary of Health and Human Services to issue guidance by 2028 on how insurers must present plan details, like premiums and deductibles, in a standard, plain English format.

Improves plan comparison on health exchanges

Requires health insurance marketplaces to include the new financial transparency data in their plan comparison tools for plan years starting in 2029.

Who does this affect?

Health insurance consumers
Health insurance companies
Medicare Advantage organizations

What is the real world impact?

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Increases consumer knowledge

Provides customers with clear information about how their insurance premiums are spent. This allows them to make more informed choices when selecting a health plan.

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Holds insurers accountable

Creates public pressure on insurance companies to spend more on actual medical care rather than on administrative costs or profits by making their spending public.

When does this start?

This bill sets several different deadlines for new transparency rules to take effect.

Insurer financial reporting

Health insurers and Medicare Advantage plans must begin publishing their overhead costs and claim payment information for plan years starting on or after January 1, 2027.

Guidance on standardized information

The Secretary of Health and Human Services must issue guidance on providing insurance information in a plain English format no later than January 1, 2028.

Health exchange plan comparison

Health insurance marketplaces must include the new financial data in their comparison tools for plan years starting on or after January 1, 2029.