Do You Need HITRUST, or Is SOC 2 Enough for Healthcare?

If a hospital system or health plan has written HITRUST into a contract or a security questionnaire, you need HITRUST, and a SOC 2 report will not substitute for it. The two artifacts answer different questions: HITRUST is a scored certification against a prescriptive control set, issued after a validated assessment by an authorized assessor, while SOC 2 is an independent auditor's opinion on controls you selected against the trust services criteria. If nobody has named HITRUST, the numbers argue for starting with SOC 2 plus documented HIPAA compliance. Priced from one source on both sides, soc2auditors.org, an ad-supported directory that takes no percentage of audit fees, puts a first-year SOC 2 at $30,000 to $150,000 (the figure aggregated from 171 firms that our SOC 2 cost breakdown works through) and a HITRUST i1 at $60,000 to $200,000.

Below: why the two are not interchangeable, what each actually proves to a reviewer, what the money looks like when you price both sides from the same place, how to sequence them, and when neither is the right purchase yet.

Key takeaways

• HITRUST is a certification; SOC 2 is an attestation. A named HITRUST requirement in a contract is not satisfied by a SOC 2 report.
• Priced from one directory on both sides as of August 2026, a first-year SOC 2 lands at $30,000 to $150,000, aggregated from cost data across 171 audit firms.
• That same directory prices a HITRUST i1 assessment at $60,000 to $200,000, which is double at the floor and about a third more at the ceiling.
• The overlap in underlying control work is large; the reporting is what differs, and that is where the second bill comes from.
• For most health tech companies with no HITRUST requirement in hand, SOC 2 Type II with HIPAA mapping removes the most sales friction per dollar.
• Buying HITRUST before a customer asks for it remains the most common overspend we see in this market.

Certification and attestation are different products

The vocabulary is not pedantry here. It determines whether one artifact can stand in for the other.

A HITRUST validated assessment is performed by a HITRUST Authorized External Assessor against a defined requirement set, scored, and then reviewed by HITRUST before a certification issues. The control set is prescriptive: HITRUST decides what is in scope, informed by your scoping factors, and grades how well you meet it. When a customer asks for HITRUST, they are outsourcing the judgment about which controls matter to HITRUST.

A SOC 2 report is an independent CPA firm's opinion, under attestation standards, on a description of a system and the suitability and operating effectiveness of the controls you selected against the applicable trust services criteria. There is no score and no pass. The correct description of a clean result is an unmodified opinion, and what a reviewer reads is the opinion paragraph and the exceptions rather than a grade.

So the substitution fails in one direction for a structural reason. A reviewer who asked for HITRUST wanted a third party to have chosen the controls. Handing them a report where you chose the controls does not answer their question, however good the report is. The reverse substitution fails too, though it comes up less: a customer who asked for SOC 2 usually wants the system description and the exceptions, and a HITRUST certificate does not contain those.

What each one actually proves to a reviewer

Sit on the other side of the vendor review for a moment, because that is whose behavior you are buying.

A SOC 2 Type II tells a reviewer that an independent auditor examined a described system over a period, sampled evidence, and issued an opinion, and it tells them exactly what went wrong via the exceptions. It is the most widely understood security artifact in the US market, which is why it clears the most questionnaires per dollar. Its weakness in a healthcare review is that you chose the scope, so the reviewer has to read the system description carefully to see whether the systems handling their data are actually inside it.

A HITRUST certification tells a reviewer that a third party graded you against a control set the reviewer did not have to evaluate. That is enormously convenient for a large health plan processing hundreds of vendors, which is exactly why some of them ask for it. Its weakness is cost and rigidity: you are certified against HITRUST's requirement set, not against the specific things this customer cares about.

Neither of them is HIPAA compliance. HIPAA has no certification scheme at all, which we work through in is there such a thing as HIPAA certification. Both artifacts are ways to evidence a program that also has to satisfy the Security Rule on its own terms, including the risk analysis obligation that neither report replaces.

The money, priced from one source on both sides

Cross-source cost comparisons are where compliance content usually goes wrong: a SOC 2 number from one place, a HITRUST number from another, and a conclusion that is really an artifact of two different methodologies. So price both sides from the same place.

The directory soc2auditors.org publishes a first-year SOC 2 range of $30,000 to $150,000, aggregated from 171 firms, and that is the figure our own SOC 2 cost breakdown uses and decomposes. The same directory publishes HITRUST all-in ranges of $20K to $70K over 3 to 4 months for e1, $60K to $200K over 6 to 12 months for i1, and $150K to $300K or more over 9 to 24 months for r2. Our tier comparison shows a second source that disagrees, which is worth reading before you commit a budget.

Our budget planner prices HITRUST by row rather than by tier: $45,000 to $75,000 for the gap analysis, $55,000 to $110,000 for remediation, $40,000 to $80,000 for what it labels audit fees, and $25,000 to $50,000 a year for ongoing maintenance, as mid-market planning estimates for a 51 to 200 person company, whereas the directory's figures are all-in totals per assessment type, so the two are not the same measure and should not be expected to match.

The arithmetic, then. Bottom to bottom, HITRUST i1 at $60,000 is double SOC 2 at $30,000. Top to top, $200,000 against $150,000, it is a third more. The gap is real but it is not the order-of-magnitude difference the marketing on either side implies, and it narrows at the top precisely because a large, complex environment costs a lot to audit no matter what standard you audit it against.

What the numbers do not show is the overlap. Access control, change management, logging and monitoring, vendor management, incident response, encryption: this work is shared, and if you have done it for one you have done most of it for the other. The second bill is mostly reporting, evidence formatting and the assessor or auditor fee, not a second security program. That is the whole argument of reusing compliance evidence across frameworks, and it is why "we already did SOC 2" makes a later HITRUST cheaper than a cold start, without making it cheap.

Sequencing, and what each purchase buys you later

Here is the rule we actually apply.

If a signed or near-signed contract names HITRUST, buy HITRUST, at the tier the contract names. No amount of reasoning about how good SOC 2 is will change a vendor risk team's checklist inside a deal cycle.

If nobody has named it, buy SOC 2 Type II and map it to the Security Rule. It is the artifact the widest range of buyers already knows how to read, it costs less at the entry end, and the mapping document that connects the trust services criteria to the HIPAA safeguards is a fraction of the cost of a second assessment.

If your buyers are large health plans and you are pre-revenue with them, wait anyway. Certifying against a requirement you have not yet been given is speculative spending, and the tier they eventually name may not be the one you would have guessed.

There is one situation where we would reverse this. If your entire go-to-market is health plans, every deal in your pipeline has raised HITRUST, and you can absorb the cost, going straight to HITRUST and skipping SOC 2 is defensible: you avoid paying twice for reporting on a control set you would have built either way. That is a narrow case, and it depends on real evidence from real deals rather than on what a market map says health plans want.

When neither is the right purchase yet

We sell readiness for both. Here is when not to buy either from us or from anyone.

If you have no ePHI in production, no signed customer, and no security questionnaire in flight, the money does more for you in the product and in the basic controls. Encryption, logging, access reviews, offboarding, a written risk analysis. Those are the substrate under every artifact, they are required of you today under the Security Rule regardless of what you buy, and starting with them means the eventual assessment is a measurement rather than a remediation project.

If you already hold a current SOC 2 Type II that genuinely covers the ePHI-handling systems, and a customer is asking a HIPAA question rather than a HITRUST question, the right purchase is usually a mapping exercise, not another audit. That is a smaller engagement than either option in this article, and we say so even though the smaller engagement is worse business for us.

And if you are being told a certification will make you HIPAA compliant, get a different advisor. It will not. It evidences a program; the obligations remain yours.

Where Top Floor fits

We do SOC 2 readiness and HITRUST readiness, and the Security Rule work that sits underneath both under our HIPAA practice. Where a company needs the mapping document rather than a second audit, that is a scoped piece of work rather than a program.

The limits, stated plainly: we do not issue SOC 2 opinions, and we are not a HITRUST Authorized External Assessor. We prepare organizations for both and coordinate with the firms that do issue them. A firm offering to remediate your gaps and then attest to the result has a conflict you should ask about before signing.

How to decide this week

Search your last ten security questionnaires and contracts for the word HITRUST. Not your impression of what customers want, the actual documents. If it appears, note whether a tier is named. That search takes twenty minutes and it decides most of this.

If HITRUST does not appear anywhere, ask your two largest prospects what artifact would clear their vendor review. In our experience the answer is a SOC 2 Type II far more often than anything else, and the answer arrives faster than any assessment does.

If it does appear, get the tier confirmed in writing, then read our tier comparison before you scope, because the difference between e1 and r2 is the difference between a quarter and a year.

Frequently asked questions

Does a SOC 2 report satisfy a HITRUST requirement?

No. HITRUST is a certification issued after a validated assessment by an authorized external assessor against a prescriptive, scored control set, while SOC 2 is an independent auditor's opinion on controls you selected against the trust services criteria. A customer who asked for HITRUST wanted a third party to decide which controls matter, and a SOC 2 report does not answer that question no matter how strong the report is. If the contract language is ambiguous, ask the customer's vendor risk team to confirm in writing what they will accept before you scope anything.

Which costs more, SOC 2 or HITRUST?

Priced from the same source, HITRUST costs more, though less dramatically than the marketing on either side suggests. The directory soc2auditors.org publishes a first-year SOC 2 range of $30,000 to $150,000, aggregated from cost data across 171 audit firms. The same directory prices a HITRUST i1 assessment at $60,000 to $200,000. That is double at the bottom of both ranges and about a third more at the top. The underlying security work overlaps heavily, so the second artifact is mostly incremental reporting, evidence formatting and assessor fees rather than a second security program.

Do health plans require HITRUST?

Some do and many do not, and the only reliable answer is the one in the contract in front of you. HITRUST is asked for most often by large health plans and large provider organizations, because grading hundreds of vendors against a common control set is cheaper for them than evaluating each vendor's chosen controls. Do not infer the requirement from a market map or a vendor blog. Search your own questionnaires and agreements for the word, and if it appears, get the tier confirmed in writing.

Does either one make us HIPAA compliant?

Neither one does, because HIPAA has no certification scheme and no artifact substitutes for the obligations themselves. Both a SOC 2 Type II and a HITRUST certification evidence a large share of the same control ground the Security Rule covers, particularly access control, change management, logging and vendor management. Neither replaces the HIPAA-specific duties: the risk analysis at 45 CFR 164.308(a)(1)(ii)(A), the business associate agreement chain, and the breach notification procedures. Most health tech companies pair whichever report they buy with a mapping document that shows a reviewer how the two line up.