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 went into effect in 2022 and 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 BlogA third interim final rule (on the independent dispute resolution process, good faith estimates, and more) is summarized in two parts at the Health Affairs Blog and for The Commonwealth Fund. We have also summarized a final rule on the independent dispute resolution process at the Health Affairs Blog.

Commonwealth Fund legislation tracking map

Enforcement of the No Surprises Act. In enacting the No Surprises Act, Congress looked to states to enforce the law’s major provisions against insurers and providers. This new interactive map from CHIR experts summarizes the roles of the federal and state governments on enforcement, specified state laws for payment determination, the use of external review for surprise-billing cases, and the patient–provider dispute resolution process.

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.