HR3911-119

What This Bill Does

The Choose Medicare Act creates a public insurance option called Medicare Part E and pairs it with broader marketplace affordability rules. HHS must establish Medicare Part E plans in the individual, small group, and large group markets. The plans must be ACA qualified health plans, cover essential health benefits plus Medicare-covered items and services, provide gold-level coverage, and cover abortions plus other reproductive services despite state-law prohibitions. Individual and small group Part E plans must be sold through federal and state Exchanges, including SHOP Exchanges. Any U.S. resident who is not already entitled to Medicare Part A or enrolled in Part B and is not incarcerated can enroll. Employers that do not offer employer-sponsored coverage, or offer coverage that is unaffordable or fails minimum value, must refer full-time employees to an ACA navigator or equivalent entity at hiring or when the rule takes effect. Traditional Medicare beneficiaries get a new annual out-of-pocket cap beginning in 2027: $6,700, indexed by the medical care CPI component, covering Part A and Part B deductibles, coinsurance, copayments, and covered services after benefit exhaustion, with rules excluding noncovered services and excess non-assignment charges. ACA premium tax credits shift from the second-lowest-cost silver plan to the second-lowest-cost gold plan and remove the upper income cap, while cost-sharing reductions shift from silver to gold and require actuarial values of 94 percent, 92 percent, 90 percent, 85 percent, and 80 percent across income bands from 100 to 400 percent of poverty. A new $30 billion reinsurance and affordability fund for fiscal years 2026 through 2028 lets states fund reinsurance for individual-market issuers or other assistance reducing premiums, deductibles, copayments, and coinsurance for Exchange enrollees. The bill extends ACA rating rules to large group plans, lets states adopt stronger rate-review rules, requires HHS to decide when state regulators or HHS will take corrective action on excessive, unjustified, or unfairly discriminatory rates, and allows rate denial, modification, rebates, civil monetary penalties, and qualified-health-plan ineligibility. The final sense of Congress says the federal government should model reproductive-service coverage and private-market restrictions should end.

Who Benefits and How

Medicare Part E enrollees benefit from a public plan option with essential health benefits, Medicare-covered services, gold-level coverage, and reproductive-service coverage. ACA marketplace consumers benefit from premium tax credits benchmarked to gold plans, no 400 percent income cliff, stronger cost-sharing reductions, and state affordability funds. Medicare beneficiaries benefit from a $6,700 indexed annual out-of-pocket cap for Part A and Part B cost-sharing beginning in 2027. Full-time employees lacking affordable coverage benefit from required referrals to navigators or equivalent enrollment-help entities. State reinsurance programs benefit from a $30 billion federal fund for 2026 through 2028. Reproductive health patients benefit because Medicare Part E plans must cover abortions and all other reproductive services despite contrary state law.

Who Bears the Burden and How

CMS plan operations staff must design and operate Medicare Part E plans across three insurance markets and Exchanges. Employers lacking affordable coverage must refer full-time employees to navigators when workers are hired or when the rule takes effect. Health insurance issuers face competition from Medicare Part E and stronger rate-review corrective actions. IRS premium tax credit staff must administer gold-benchmark credits, remove the 400 percent cap, and update applicable-percentage rules. State insurance regulators must coordinate with HHS on rate review, corrective actions, and reinsurance or affordability programs. Federal taxpayers bear the cost of premium-credit expansion, cost-sharing reductions, reinsurance funding, Medicare out-of-pocket protection, and public-plan administration.

Key Provisions

• Creates Medicare Part E public health plans in individual, small group, and large group markets.
• Requires Part E plans to cover essential health benefits, Medicare-covered services, gold-level benefits, abortions, and other reproductive services.
• Requires employers lacking affordable minimum-value coverage to refer full-time employees to ACA navigators or equivalent help.
• Provides a $6,700 indexed annual out-of-pocket cap for Medicare Part A and Part B cost-sharing beginning in 2027.
• Expands premium tax credits by benchmarking to gold plans and removing the 400 percent income cap.
• Expands cost-sharing reductions by moving them to gold plans and setting 94, 92, 90, 85, and 80 percent actuarial-value levels.
• Appropriates $30 billion for 2026 through 2028 state reinsurance or affordability assistance.
• Extends ACA rating rules to the large group market and strengthens rate-review corrective actions.
• Provides a sense of Congress favoring federal reproductive-service coverage and ending private-market restrictions.