The No Surprises Act

The No Surprises Act

As part of a year-end deal in 2020, Congress enacted the No Surprises Act, a new law that protects patients from surprise medical bills. These comprehensive new protections will go into effect beginning in 2022 and will protect patients from surprise medical bills for emergency services (including air ambulances) and non-emergency services provided at an in-network facility. Patients’ out-of-pocket costs will be limited to the costs they would have paid if they had received services from an in-network doctor, hospital, or other health care provider.

Although many states have protected patients from surprise medical bills, federal legislation was necessary to fill gaps in state authority and extend similar protections to the more than 135 million people estimated to be covered by employer self-funded plans.

Here are some resources to help better understand this historic new law and what it means for policymakers, patients, and industry stakeholders.


Learn more about the No Surprises Act. Want to understand more about the historic new No Surprises Act? Read our high-level summary and detailed summary for The Commonwealth Fund and check back as we watch to see how the Biden administration implements the new law. Dive even deeper in this post for the Health Affairs Blog which has all the wonky details that you need to know about the No Surprises Act. For those looking for even more information, check out our new compilation of resources.

White house, Washington DC, USA

New rules to implement the No Surprises Act. The Biden administration has issued new rules to implement the No Surprises Act. The first rule (on new patient protections, interactions with state law, and a methodology for the qualifying payment amount) is summarized for The Commonwealth Fund and the Health Affairs Blog. The second rule (on air ambulance data and enforcement) is summarized at the Health Affairs Blog. And the third rule (on the independent dispute resolution process) is summarized in two parts at the Health Affairs Blog and for The Commonwealth Fund.

Commonwealth Fund legislation tracking map

Preemption of state laws. In enacting the No Surprises Act, Congress recognized that many states already passed (or will pass) state-level protections against surprise medical bills. Congress thus deferred to some state laws and limited the degree to which the No Surprises Act preempts state laws. This new fact sheet from CHIR experts summarizes our current understanding of this preemption framework and highlights considerations for policymakers.

Meeting at a table

Will the No Surprises Act inflate health care costs?  It depends. The Biden administration has considerable ability to avoid inflationary impacts in implementing the No Surprises Act. Read our analysis for The Commonwealth Fund and how federal regulators could look to lessons learned from state experiences.

Meeting at a table

Enforcement of the No Surprises Act. The No Surprises Act builds on the existing enforcement framework for insurers and group health plans – and extends new requirements to health care providers (including air ambulances) and facilities. This new fact sheet from CHIR experts summarizes the enforcement framework, options for states, and considerations for policymakers.