The gap between what healthcare members expect and what price transparency tools deliver is real.

Members want the same clarity and ease they get in retail or banking, but too often they face fragmented data, disconnected experiences and estimates that do not help them make decisions.

Payers can close the expectation gap, but it takes more than checking a compliance box. The real value comes from transparency tools that feel actionable, connected and easy to use.

When price transparency moves from a requirement to a member experience strategy, it builds trust, strengthens relationships and helps care flow more seamlessly.

63%
of employers value transparency
<50%
are satisfied with current tools
29%
say their cost estimation tool meets their needs

TL;DR

Why it matters:
  • Members want clear, actionable cost information from payers.
  • Most current transparency tools do not reflect real member needs.
  • Moving beyond compliance builds trust with members and providers.
  • The biggest wins come from connected data, personalization and availability at every touchpoint.
Bottom line: Transparency earns trust when it is connected, personalized and easy to use, not when it is buried behind disconnected tools.

Why is there an expectation gap in healthcare?

Healthcare consumers expect a shopping experience that feels as seamless and supported as any other. But that is not currently the norm.

Estimates without context
Most tools provide procedure estimates without guidance, quality signals or next steps.
Low satisfaction
Employers value transparency, but fewer than half are satisfied with what they have today.
Member needs unmet
Only 29 percent say their cost estimation tool meets their needs.

People want more than numbers. They want clarity, confidence and help making decisions that fit their lives.

Transparency works when it helps members decide, not when it simply produces a price.

Three forces driving the push for better price transparency

Payers are responding to three trends that are reshaping what members and employers expect from transparency tools.

1. Gaps in current tools
Members and employers want personalized insights and a clear path to next steps.
2. Digital transformation
Connected ecosystems replace disconnected platforms, linking directories, comparison and engagement tools.
3. Generational differences
Adoption varies by age, so intuitive design and support matter more than ever.
73%
of Gen Z use cost tools
49%
of Baby Boomers use cost tools

How can payers close the transparency gap?

Meeting expectations starts with strategies built around member needs, not tool checklists.

Connect cost to decisions
Pair cost data with quality metrics and care options, then streamline provider search, authorizations and next steps.
Personalize estimates
Tailor estimates to plan design, deductible status and real member context so the number reflects reality.
Make access effortless
Bring pricing to mobile, portals, employer sites and phone support, without adding friction.

Transparency should show up across the full financial journey, including claims payment status, digital settlement options and financial resources that help members move forward.

Transparency is not just a requirement. It is an opportunity to build trust and engagement and enable care to flow more seamlessly.

Where payers can create the biggest impact

The biggest opportunities sit at the intersection of connection and experience.

Connect cost and quality
Help members weigh care options with both pricing and quality signals in one place.
Make estimates feel personal
Use plan and member context to deliver estimates members can actually trust.
Deliver at every touchpoint
Bring transparency into the moments members already use, not a standalone tool they have to find.

By meeting expectations for easy access, accurate information and ongoing support, payers can close the transparency gap and drive better experiences for everyone involved.

Explore the research
See how consumers, employers and payers view healthcare finance and where transparency can lead the way
Learn more

Source: Proprietary research commissioned by Zelis and led by Datos Insights.