Congressman August Pfluger (R) has introduced legislation that would require health insurers and Medicare Advantage plans to publicly disclose how premium dollars are spent, while also standardizing benefit information to help consumers compare health plans more easily.
What is the Premium Transparency Act?
The Premium Transparency Act is a bill aimed at increasing transparency in the health insurance market by requiring insurers to disclose how much of each premium dollar goes toward patient care versus administrative costs and profits.
The legislation would direct the U.S. Department of Health and Human Services (HHS) to create standardized, plain-language explanations of health plan benefits, deductibles, and cost-sharing requirements.
Pfluger said the measure would give consumers a clearer understanding of how their health insurance premiums are being used.
What Pfluger is saying
Rep. August Pfluger: "Americans deserve to know where their health insurance dollars are actually going."
Rep. Pfluger continued: "This legislation changes that, bringing prices into the open in plain language that any patient, family, or employer can understand."
What would the bill do?
The Premium Transparency Act would require commercial health insurers in both individual and group markets to publicly report beginning in the 2027 plan year:
- The percentage of premium dollars spent on patient claims
- Spending on quality improvement initiatives
- Administrative costs and profits
The bill would also apply similar disclosure requirements to Medicare Advantage plans, requiring public reporting of revenue, claims spending, non-claims costs, and medical loss ratios.
Support from Texas Lawmakers
Rep. Nathaniel Moran (R) voiced support for the legislation, arguing that consumers need clearer information when selecting health coverage.
Rep. Nathanial Moran: "Hardworking families deserve to understand their health plans."
The Bottom Line
Pfluger's Premium Transparency Act seeks to increase accountability in the health insurance industry by making insurer spending more visible and simplifying plan comparisons for consumers. Supporters argue the proposal would help patients better understand health care costs and make more informed coverage decisions.
