New Health Options Act of 2025
Summary
What This Bill Does
The New Health Options Act creates three health-insurance affordability and transparency rules. First, it establishes an HHS-administered reinsurance program for certain off-Exchange plans from 2026 through 2030, funded by $50 per eligible member month and capped at $6 billion per year, to pay issuers for claims and lower premiums. Reinsurance funds cannot pay for specified abortion services. Second, group health plans and issuers must, at the enrollee's option, count certain out-of-network costs toward in-network deductibles and out-of-pocket maximums when the item or service is covered and the out-of-network charge is equal to or below specified plan-related amounts. Third, beginning January 1, 2026, providers and facilities must disclose when a patient's cost sharing under insurance or a federal health care program would exceed the cash price charged to someone without such coverage, and harmed individuals may sue for violations.
Who Benefits and How
Off-Exchange health insurance enrollees benefit if reinsurance payments reduce premiums for covered plans. Health insurance issuers benefit from federal reinsurance payments for eligible claims. Patients using lower-priced out-of-network providers benefit when qualifying costs count toward in-network deductibles and out-of-pocket maximums. Patients comparing cash prices benefit from disclosure when cost sharing exceeds the no-insurance charge.
Who Bears the Burden and How
Department of Health and Human Services staff must administer the reinsurance program and set payment parameters. Health plans and issuers must apply qualifying out-of-network costs to in-network cost-sharing limits. Health care providers and facilities must disclose lower cash prices to insured and federal-program patients. Federal taxpayers bear reinsurance costs capped at $6 billion per year.
Key Provisions
- Creates an HHS reinsurance program for certain off-Exchange plans from 2026 through 2030.
- Limits annual reinsurance appropriations to $6 billion and bars use for specified abortion services.
- Requires qualifying out-of-network costs to count toward in-network deductibles and out-of-pocket maximums.
- Requires providers and facilities to disclose when cost sharing exceeds the cash price.
- Creates a private action for individuals harmed by lower-price disclosure violations.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Creates a temporary HHS reinsurance program for certain off-Exchange health plans, requires qualifying out-of-network costs to count toward in-network deductibles and out-of-pocket maximums, and mandates lower cash-price disclosures by providers and facilities.
Key Policy Areas
Health Insurance, Price Transparency, Health Care
Primary Purpose
Creates a temporary HHS reinsurance program for certain off-Exchange health plans, requires qualifying out-of-network costs to count toward in-network deductibles and out-of-pocket maximums, and mandates lower cash-price disclosures by providers and facilities.
Policy Domains
Resolution provisions
Identified Gains
- Off-Exchange health insurance enrollees
- Health insurance issuers
- Patients using out-of-network providers
- Patients comparing cash prices
Identified Costs
- Department of Health and Human Services staff
- Health plans
- Health care providers
- Federal taxpayers
Sponsors
Legislative Progress
In CommitteeMr. Palmer introduced the following bill; which was referred to …
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Health insurance issuers, Off-Exchange health insurance enrollees
Health care providers, Patients using out-of-network providers
Positive-direction: Patients using out-of-network providers
Negative-direction: Health care providers
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology