Indiana sets new health insurance cost-sharing rules effective January 2026

House Bill 1604, introduced in the Indiana House on April 23, 2025, aims to enhance transparency and affordability in health care by establishing new provisions for health insurance plans. The bill primarily focuses on allowing individuals to receive credits toward their deductibles and out-of-pocket expenses for direct payments made to health care providers for medically necessary services, provided that these payments are below the average discounted rates negotiated by the health plan.

Key provisions of the bill include the requirement for health plans to create a clear procedure for individuals to claim these credits and to specify the necessary documentation. Additionally, health plans must either publish their average discounted rates or refer to data from the all-payer claims database, which is designed to provide consumers with information on typical costs for health care services.

The bill has sparked notable discussions among lawmakers and health care advocates. Proponents argue that it will empower consumers by giving them more control over their health care expenses and encouraging price transparency. Critics, however, express concerns about the potential administrative burden on health plans and the effectiveness of the all-payer claims database in providing accurate and accessible information.

Economically, the bill could lead to reduced health care costs for consumers, potentially alleviating some financial strain on families. Socially, it aims to promote fairness in health care pricing, addressing long-standing issues of affordability and access. Politically, the bill reflects a growing trend among states to reform health care systems in response to rising costs and consumer demand for greater transparency.

As House Bill 1604 moves through the legislative process, its implications for Indiana's health care landscape remain to be seen. If passed, the provisions are set to take effect on January 1, 2026, marking a significant shift in how health care costs are managed and communicated to consumers in the state.