Health plans will have to answer price questions by telephone, not just on a website, once a new federal rule takes hold. The rule applies to plan years that begin on or after January 1, 2027. A plan may also stop quoting a caller after no fewer than 20 providers in a day.
The Departments of Health and Human Services, Labor and the Treasury issued the final rule, which the Federal Register published on October 6, 2026. It is effective on December 7, 2026, but the phone requirement does not apply until the 2027 plan year begins.
Who is covered, and which date counts
The CMS fact sheet says the rules cover non-grandfathered group health plans and issuers of non-grandfathered group or individual coverage. That means employer-sponsored plans and plans bought on the individual market, with some older grandfathered plans outside the main rules. The announcements describe group and individual coverage and do not mention Medicare plans.
People with an employer plan or an individual plan are the ones who will be able to use the new phone service, and they should mark two dates. December 7, 2026 is when the regulations take effect. The phone duty begins with plan years starting on or after January 1, 2027, and the rule says earlier requirements stay in place until then. A plan whose year begins later in 2027 starts later. The Departments said plans and issuers have anticipated a phone requirement since 2021 and have already made progress toward it.
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What a plan has to do when someone calls
Under the rule, group health plans and insurers must give a member personalized cost-sharing information by phone, in addition to the online tool and paper copies. The CMS announcement of October 5, 2026 says the goal is to let people compare costs before they get care. Dr. Mehmet Oz, the CMS administrator, said people should know what their health insurance will cover and what they will need to pay before receiving medical care.
The call has to reach the same customer-assistance number printed on the member’s insurance card. The duty belongs to the plan or insurer, even when it hires an outside company to run its call center. The Departments chose not to add phone standards such as required hours of operation.
The Federal Register text says the Departments finalized the phone requirement as proposed, with only minor edits. Plans have until their first 2027 plan year to build or adjust the service.
Why plans may stop at 20 providers a day
The final rule lets a plan limit the number of providers it will quote on the phone to no fewer than 20 providers per day. The Departments describe 20 as a maximum limit that plans may impose, not a number every call must reach. The count runs on a per-operational-day basis, meaning each day the call center is open.
The idea is not new. In the 2020 rules, the Departments set a limit of no fewer than 20 providers per request for paper-based disclosures, and the new rule carries a matching limit over to the phone. A caller who runs into the cap on one day can call again the next operational day for the rest of the list.
A plan that uses the limit has to tell the caller about it when the request is made. The phone limit is counted separately from the one for paper requests, so using one channel does not use up the other. For someone shopping for a surgeon, a lab and a pharmacy, 20 names in a day is likely more than enough. For a person who wants every cardiologist in a metro area priced, the cap can bind.
What else the rule changes
The same rule reshapes the machine-readable price files that plans post online. It lowers the claims threshold for reporting out-of-network allowed amounts from 20 claims to 11, moves updates from monthly to quarterly, and requires plans to attest that the information is accurate and complete to the best of their knowledge. The CMS fact sheet says the Departments estimate a net cost savings to plans and issuers of about $174.5 million a year from the second year.
The rule follows a 2025 order. A February 25, 2025 executive order on healthcare price information told the Treasury, Labor and Health and Human Services secretaries to require disclosure of actual prices of items and services, not estimates. The final rule was filed for public inspection on October 5, 2026, a day before it ran in the Federal Register.
A quote by phone is a price, not a discount. The rule makes a plan state what the member would owe under the plan’s own cost-sharing. It does not lower a deductible, cap a bill or cover anything the plan excludes. People who hear a number they cannot afford still have to look elsewhere for help.
CMS says the larger aim is to bring prices down. Its October 5 release cites data showing that the top 25% of the most expensive healthcare service prices dropped 6.3% per year after price transparency requirements were first implemented. The same release lays out a longer schedule for prescription drug pricing, with plans expected to start publishing drug files in December 2027.
Hearing a price over the phone that is still out of reach?
Getting a price by phone answers what a visit or prescription will cost. It does not change the number. Households on a fixed income often find the next step is a benefit program that covers the cost, and those programs must be applied for, usually against an income limit.
The Benefits Checklist scans 11 benefit programs retirees most often miss, including Medicare Savings Programs, Extra Help and SNAP, and sets out the 2026 income limits for each. It adds a 50-state phone directory, so the call after the plan call goes to the right office.
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
