Trying to find out what a test or procedure will cost before you go can feel impossible. Insurance companies have had online price tools for a few years now, but if you don’t have a computer, don’t do well with websites, or have trouble seeing a screen, those tools haven’t helped you much.
That’s changing. Starting with plan years that begin on or after January 1, 2027, many private health plans must give you a personalized cost estimate over the phone when you ask, according to a new federal rule.
What Can I Ask For?
You can ask for the same cost information your plan already shows in its online price tool. That means an estimate of what you’d pay out of your own pocket for a covered service, like an MRI, knee surgery, or specialist visit, based on your plan’s deductible, copays, and coinsurance.
The rule says the information must be accurate when you call and provided during the call, not mailed weeks later.
Your plan can limit how many doctors or facilities it provides estimates for over the phone, but it must allow requests for at least 20 providers per day that its customer service call center is operating. It also has to tell you about that limit.
That doesn’t mean your insurer must compare 20 providers during every call. It means the plan cannot set its daily limit below 20 providers.
The rule also requires a clearer, plain-language statement explaining when an out-of-network provider might send you a “balance bill” for the difference between what they charge and what your plan pays, including information about applicable federal protections against surprise billing.
How Do I Get an Estimate?
Call the customer service number on your insurance ID card. The rule specifically requires plans to use that number, so you shouldn’t have to hunt for a special line. It works with digital ID cards, too.
Before you call, it helps to have:
- The name of the service or procedure (if your doctor gave you a billing code, even better)
- The name of the doctor, hospital, or clinic you’re thinking about
- A pen and paper to write down the estimate, the date, and the name of the person you spoke with
If you’re comparing a few places, ask for an estimate at each one. Prices for the same service can be very different from one facility to the next.
The estimate must be provided without charging you a fee for the disclosure.
Is the Estimate a Guarantee?
No, and it’s important to know that going in.
Your final bill could be different if your doctor adds services, bills them differently, or if a provider you didn’t expect, like an anesthesiologist, is involved.
So when you call, ask two follow-up questions:
- “Is this provider in my network?”
- “Does this estimate include everyone who will bill me, or just the facility?”
Those two answers could help you avoid some of the biggest surprises.
Keep in mind that federal surprise billing protections may apply to certain out-of-network charges, even when a provider isn’t in your plan’s network.
Who Does This Apply To?
The new Transparency in Coverage requirements generally apply to non-grandfathered job-based health plans and individual health insurance, including plans you purchase on your own.
Grandfathered health plans have related price-comparison obligations under the No Surprises Act, but they aren’t subject to every requirement of this particular rule.
The new phone requirements start with plan years beginning on or after January 1, 2027.
That means not everyone’s coverage will be affected on January 1.
If your employer’s health plan year begins in July, for example, the new requirement would generally begin with that plan year in July 2027.
The rule doesn’t apply to Medicare Advantage or Medicaid managed care plans. The federal agencies specifically identified those plans as outside the scope of this regulation.
What If I Have Medicare, Medicaid, or No Insurance?
If you’re on Medicare or Medicaid, you can still ask about your expected costs before receiving care.
Call the number on your insurance card or contact your plan to ask whether a service is covered and what you might owe.
Medicare and Medicaid have their own coverage rules and ways to obtain information about costs. They aren’t subject to this particular Transparency in Coverage phone requirement.
If you don’t have insurance, or you choose not to use your coverage, you have a different protection.
Doctors and facilities generally must provide a written Good Faith Estimate when you schedule eligible care at least three business days in advance or request an estimate, according to CMS.
A Good Faith Estimate explains the expected charges for your care before you receive it.
If a provider’s bill is at least $400 more than that provider’s Good Faith Estimate, you may qualify to dispute the bill through the federal patient-provider dispute resolution process.
You generally have 120 calendar days from the date on your initial bill to start that dispute, so keep your estimate somewhere safe.
If a bill has already arrived and it doesn’t look right, our guides on how to dispute a medical bill and what to do about surprise medical bills walk you through your options.
And if you just can’t afford the bill, see our list of ways to get help with medical bills.
Relief Recap
A phone call shouldn’t be harder than a website, and starting in 2027, many private health plans must make personalized cost estimates available by phone.
If you have a test, procedure, or specialist visit coming up, call the customer service number on your insurance card and ask what you’re expected to pay. Check whether your providers are in-network, ask about separate charges, and write down the estimate.
Remember that an estimate isn’t a guarantee of your final bill, and the new requirement begins with your plan year starting on or after January 1, 2027.
If you have Medicare, Medicaid, or no insurance, you still have ways to ask about costs before receiving care. Knowing what to expect can help you compare your options and avoid unnecessary financial surprises.
