Reducing Patient Costs: The Impact of the No Surprises Act on Out-of-Pocket Medical Spending

No surprises Act Delivers $600 in Annual Savings, But Healthcare Affordability Crisis Persists

Boston, MA – August 27, 2025 – A new study published today in The BMJ reveals the significant financial impact of the No Surprises Act, a 2022 law designed to protect patients from unexpected medical bills.Researchers at Mass General Brigham and the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel deaconess Medical Center found the Act resulted in an average annual savings of nearly $600 per patient by dramatically reducing out-of-pocket costs.

Prior to the Act, one in five insured adults in the U.S. faced surprise medical bills, often totaling thousands of dollars and causing significant financial hardship. This new research,analyzing data from over 17,000 adults with private insurance,provides the frist rigorous evaluation confirming the law’s success in shielding patients from these unexpected expenses.

“Government agencies have called for rigorous evaluations of the law, and we believe our paper is the first to do so,” stated dr. Michael liu, lead author and a clinical fellow at Brigham and Women’s Hospital.

The study compared spending in states that gained new protections under the Act with those already having complete surprise billing laws. The results clearly demonstrated a significant decline in out-of-pocket medical spending in intervention states following the Act’s implementation.

However, the research also uncovered a concerning trend: despite expectations that insurance premiums woudl decrease due to fairer negotiations between insurers and providers, premium spending remained unchanged. Researchers suggest providers, especially those backed by private equity, may be exploiting loopholes to maintain higher payments.

Moreover, the No Surprises Act did not significantly reduce the burden of high medical spending – defined as exceeding 10% of a family’s income – highlighting the need for continued policy efforts to address healthcare affordability, especially for vulnerable populations.

“Our findings have important implications for patients and should inform ongoing policy efforts to prevent financial toxicity and address the healthcare affordability crisis in the U.S.,” said senior author Dr.Rishi Wadhera,Associate Director of the Smith Center.

This study underscores the importance of the No Surprises Act as a crucial step towards protecting patients, while simultaneously revealing the ongoing challenges in achieving truly affordable healthcare for all Americans.

What cost-sharing limits does the No Surprises Act impose on emergency care?

Understanding the No Surprises Act: A Game Changer for Healthcare Costs

The No Surprises Act, which went into effect on January 1, 2022, represents a landmark shift in protecting patients from unexpected medical bills. Prior to this legislation, individuals often faced exorbitant costs for out-of-network care, particularly in emergency situations or when receiving services at in-network facilities but unknowingly being treated by out-of-network providers.This often resulted in “surprise billing” – bills significantly higher than what insurance covered, leaving patients with ample out-of-pocket expenses. The Act aims to eliminate these unexpected costs and increase healthcare affordability.

How the No Surprises Act Protects Patients

The core principle of the No Surprises Act is to treat patients as if they received care within their insurance network, irrespective of whether the provider is actually in-network. This protection applies to several key scenarios:

Emergency Services: If you seek emergency care at an out-of-network hospital, the Act limits your cost-sharing (copays, coinsurance, and deductibles) to what you would pay if the care were delivered at an in-network emergency room.

Non-Emergency Services at In-Network Facilities: When you receive non-emergency services at an in-network hospital or ambulatory surgical center, you are protected from surprise bills from out-of-network providers who may be involved in your care (e.g., anesthesiologists, radiologists).

Air Ambulance Services: The Act also provides protections against surprise bills for air ambulance services, both emergency and scheduled.

Key Provisions and Cost-Sharing Limits

The No Surprises Act doesn’t eliminate all medical bills, but it significantly reduces the financial burden on patients. Here’s a breakdown of the key provisions related to cost-sharing:

1. Emergency Care: Your cost-sharing is capped at the in-network rate.
2. Non-emergency Care at In-Network Facilities: Your cost-sharing is limited to your in-network copay, coinsurance, and deductible.
3. Notice and Consent: In certain situations, you may be asked to waive your protections under the Act and agree to pay out-of-network rates. Though, this requires a clear and informed consent process, including a good faith estimate of the expected charges.
4. Independent Dispute Resolution (IDR): if a provider and insurer can’t agree on a payment amount,they can enter into an IDR process to determine a fair price. this process is designed to prevent providers from billing patients the difference.

The Impact on Out-of-Pocket Spending: Real Numbers & Trends

Early data suggests the No Surprises Act is having a positive impact on reducing patient financial burden.While comprehensive long-term data is still being collected, initial reports indicate:

A significant decrease in the number of surprise bills reported by patients.

Lower average out-of-pocket costs for emergency and certain non-emergency services.

Increased transparency in healthcare pricing, empowering patients to make more informed decisions.

The Kaiser Family Foundation (KFF) has been tracking the implementation of the Act and provides ongoing analysis of its impact on healthcare costs and access to care. https://www.kff.org/health-policy/no-surprises-act/

Navigating the No Surprises Act: Practical Tips for Patients

Here are some actionable steps you can take to protect yourself from surprise medical bills:

Verify Network Status: Before receiving care, confirm that your providers and facilities are in-network with your insurance plan.

Ask Questions: Don’t hesitate to ask for a good faith estimate of the expected charges, especially for