Rep. Pfluger Leads Legislation to Bring Price Transparency to Health Insurance Premiums

WASHINGTON, DC - Today, Congressman August Pfluger (TX-11) introduced the Premium Transparency Act to require health insurers and Medicare Advantage plans to publicly disclose exactly what share of every premium dollar goes to patient care versus overhead and profit. This bill also directs the Department of Health and Human Services (HHS) to standardize how insurers communicate benefits and cost-sharing, giving consumers the ability to make true comparisons between plans.

"Americans deserve to know where their health insurance dollars are actually going. Right now, insurers are required to spend at least 80 to 85 cents of every premium dollar on patient care, but that data is buried in regulatory filings that few Americans ever see. This legislation changes that, bringing prices into the open in plain language that any patient, family, or employer can understand. President Trump's Great American Health Care Plan puts patients first, and the Premium Transparency Act helps codify that promise," said Rep. Pfluger (TX-11).

"Hardworking families deserve to understand their health plans. By requiring insurance companies to disclose the benefits and coverage in plain-language explanations across all plans, we're giving Americans the tools to demand better value for their health care. This is a cornerstone of President Trump's Great American Health Care plan, and it ensures that our health plans are working for patients-transparently," said Rep. Nathaniel Moran (TX-01).

Key Actions of the Premium Transparency Act:

• Requires commercial health insurers in the individual and group markets to publicly post, beginning plan year 2027, the share of every premium dollar spent on patient claims, quality improvement, and overhead or profit.

• Applies the same disclosure standard to Medicare Advantage organizations, requiring plan-level public reporting of total revenue, claims spending, non-claims costs, and the resulting medical loss ratio - at a time when Medicare Advantage gross margins per enrollee have reached $1,655, the highest of any insurance market.

• Directs HHS to issue guidance by January 1, 2028, standardizing how plans communicate premiums, deductibles, and cost-sharing for common services in plain English - and requires ACA exchanges to display this data alongside plan offerings.