The No Surprises Act (NSA), effective January 1, 2022, is a federal law protecting patients with group or individual health plans from unexpected "surprise" medical bills. It prohibits balance billing for most emergency services, air ambulance services, and non-emergency services provided by out-of-network providers at in-network facilities.

What does the no surprise act mean?

What does the No Surprises Act do? If you are in a covered plan (see Do these protections apply to me, above), the law: bans surprise bills in most emergencies, even when treatment is provided outside of your plan's network and without prior authorization.

Has the No Surprises Act been successful?

The law's ban on surprise medical bills was implemented in 2022 and has been largely successful in protecting commercially insured patients from being balance-billed when treated out of network for emergencies, receiving ancillary services at in-network facilities, and being transported by air ambulance.

How does the No Surprise Act affect patients financially?

After implementation of the No Surprises Act, out-of-pocket medical spending declined significantly in intervention states—nearly $600 annually per patient—but not in control states, indicating that the law was successful in protecting patients from surprise medical bills.

Which president signed the No Surprises Act?

The leadership of the Department of Health and Human Services (HHS, “the Department”) has been critical in implementing bipartisan No Surprises Act (P.L. 116-260), which President Trump signed into law in 2020. Over the past five years, the law has protected patients from more than 25 million surprise medical bills.

No More Surprise Medical Bills: 5 Things To Know about the No Surprises Act Taking Effect in 2022

Who enforces the No Surprises Act?

States have primary enforcement authority over health insurance issuers, facilities, and providers (including air ambulance services providers) with respect to the No Surprises Act. The Centers for Medicare & Medicaid Services (CMS) directly enforces any provision that a state fails to substantially enforce.

What changes will be made to Medicare in 2025?

Medicare changes for 2025 focus heavily on Part D prescription drug costs, introducing a $2,000 out-of-pocket (OOP) spending cap, allowing enrollees to pay drug costs monthly, eliminating the "donut hole," and shifting to the Manufacturer Discount Program, alongside increased Part A/B costs and new caregiver support programs like the GUIDE initiative.

Are there exceptions to the No Surprises Act?

The No Surprises Act Protections Do Not Apply:

Medicare (including Medicare Advantage). Medicaid (including Medicaid managed care plans). Indian Health Service. Veterans Affairs Health Care.

When did the No Surprises Act begin?

The No Surprises Act, signed into law in 2020, went into effect for most consumers enrolled in individual and group health insurance plans on January 1, 2022.

Why am I getting a bill after paying my copay?

If any part of the cost is still your responsibility, a bill is issued for that remaining balance. So while you may have paid nothing at your appointment, or you may have paid a copay, this often does not cover the full cost, even for a "fully covered" visit. That is why a bill may follow.

What changes are coming to healthcare in 2026?

Starting in 2026, a hardship exemption will expand Catastrophic plan eligibility to anyone who isn't eligible for savings on Marketplace coverage due to their income, if these plans are offered in your area.

Is it better to have straight Medicare or a Medicare Advantage plan?

Neither Original Medicare nor Medicare Advantage is inherently "better"; the best choice depends on your health, budget, and preference for flexibility versus extra benefits, with Original Medicare offering nationwide doctor choice without networks but no out-of-pocket max, while Medicare Advantage (MA) bundles benefits (often including vision/dental) with a max limit but requires using networks. Original Medicare (Parts A & B) gives broad access but requires separate Part D for drugs and possibly Medigap for costs; MA plans are all-in-one with potential $0 premiums and included Part D, but often need prior authorizations and network use.

What are the benefits of the No Surprises Act?

No Surprises Act Overview

Patients are protected from receiving surprise medical bills resulting from out-of-network care for emergency services and for certain scheduled services without prior patient consent.

What states have no surprise billing laws?

1. California

In July 2017, a new law took effect in California that protects consumers who use in-network hospitals or other health facilities, from being charged with surprise bills after receiving care from a provider who has not contracted with their insurer.

What drugs will Medicare no longer cover?

Medicare does not cover:

• Drugs used to treat anorexia, weight loss, or weight gain. ...
• Fertility drugs.
• Drugs used for cosmetic purposes or hair growth. ...
• Drugs that are only for the relief of cold or cough symptoms.
• Drugs used to treat erectile dysfunction.
• Prescription. ...
• Non-prescription drugs (over-the-counter drugs)

What free stuff can I get with Medicare?

Free preventive care services under Medicare

• Annual wellness visits. ...
• Cancer screenings and early detection. ...
• Cardiovascular disease and diabetes prevention. ...
• Shots and vaccines. ...
• Durable medical equipment (DME) coverage. ...
• Diabetes supplies and monitoring equipment. ...
• Prosthetics. ...
• Medicare-covered health education programs.

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