Georgetown Research: No Surprises Act Disputes Have Added $22B in Costs

The federal arbitration system created to resolve out-of-network medical billing disputes has generated an estimated $22 billion in additional costs, according to new Georgetown University research reported by Healthcare Dive on Aug. 26, 2026. Georgetown researchers found that accelerating dispute volumes and high arbitration award amounts have driven the price tag of the Independent Dispute Resolution (IDR) process well past what regulators originally projected when the No Surprises Act took effect.

The No Surprises Act (NSA) is a federal law, in force since Jan. 1, 2022, that protects people enrolled in employer-sponsored and individual marketplace health plans from unexpected out-of-network bills for emergency care and for certain services delivered at in-network facilities. When an insurer and an out-of-network provider can't agree on a payment amount for a covered service, either side can trigger Independent Dispute Resolution (IDR), a binding arbitration process in which a certified third-party arbitrator selects one party's proposed payment amount. According to Georgetown researchers, it is the rising number of these arbitration cases, combined with award amounts that frequently exceed insurers' initial offers, that is pushing the system's cumulative cost to $22 billion.

Healthcare Dive reports that the research warns patients could eventually shoulder part of that cost through higher insurance premiums, since insurers typically pass rising claims and administrative expenses along to policyholders over time. The findings add to an ongoing debate among regulators, insurers, and provider groups over whether the IDR process is functioning as Congress intended or needs revision.

Why This Matters Even Though Medicare Isn't Part of the IDR System

Original Medicare and Medicare Advantage are not directly subject to the No Surprises Act's arbitration process. Both already operate under separate, CMS-regulated billing rules that limit what providers can charge Medicare beneficiaries, including protections against balance billing for out-of-network emergency care. That means the $22 billion in IDR-related costs described in the Georgetown research is not landing on Medicare Advantage premiums or Part D costs through this specific mechanism.

Still, the finding is relevant to readers planning for Medicare or already enrolled. Many people approaching 65 are still covered by an employer plan or COBRA in the months before they enroll in Medicare, and those plans fall squarely within the No Surprises Act's scope, rising arbitration costs could show up in employer premium increases while readers finish out that coverage. Medicare Advantage insurers are also largely the same companies that sell commercial and marketplace plans covered by the NSA, so cost pressure in one line of business can influence how a carrier prices and designs benefits across its entire portfolio, including the Medicare Advantage bids it submits to CMS each year. More broadly, rising system-wide medical costs are one of several factors CMS weighs when setting Medicare Advantage benchmark payments and reviewing Part D bids, so claims-cost inflation elsewhere in the health system is worth watching even when it doesn't touch Medicare directly.

Key Takeaway

Medicare and Medicare Advantage already have their own balance-billing protections and are not part of the No Surprises Act's arbitration system, so this $22 billion figure doesn't translate into a direct Medicare bill today. But rising commercial insurance costs can ripple into the broader market where Medicare Advantage insurers compete for members, so it's a trend worth watching, especially if you're still on employer coverage before enrolling in Medicare.

Practical Takeaways for Medicare Beneficiaries and Soon-to-Be Enrollees

Still on employer or marketplace coverage before Medicare: Ask your HR department or insurer whether rising arbitration-related costs are factoring into next year's premium, and confirm your out-of-network protections under the No Surprises Act if you expect emergency or facility-based care before your Medicare enrollment date.
Already enrolled in Medicare Advantage: Your plan's balance-billing protections come from CMS rules, not the NSA, so ask your agent or plan directly how out-of-network emergency claims are handled and what your maximum out-of-pocket exposure looks like.
Comparing plans during an enrollment period: Treat rising system-wide cost trends as one more reason to compare Medicare Advantage, Medicare Supplement (Medigap), and Part D options every year rather than assuming last year's plan is still the best value, since carrier costs and provider networks shift annually.
Talk to a licensed agent: A licensed Medicare agent can walk through how a specific plan handles out-of-network and emergency billing, since these details vary by carrier and plan type and aren't always obvious from a plan's marketing materials.

Georgetown's research is a reminder that arbitration systems designed to protect patients from surprise medical bills can still generate costs that work their way into premiums across the broader insurance market. Medicare Plan Path will continue tracking how these commercial-market cost trends intersect with Medicare Advantage pricing and benefit design as more data becomes available.