The Choose Medicare Act would create Medicare Part E plans for individuals and employers to offer in individual, small-group, and large-group markets. Eligible U.S. residents could enroll unless they are already entitled to or enrolled in Medicare, Medicaid, or certain child health or pregnancy assistance programs. The plans would cover essential health benefits and services covered by Medicare, provide gold-level coverage, and include abortion and other reproductive services. Participating Medicare providers would also take part in Part E, and the Secretary would set payment rates within limits stated in the bill.
The bill would cap out-of-pocket cost-sharing for traditional Medicare Part A and B at $6,700 in 2027, with yearly adjustments afterward. It would also change health insurance tax credits and cost-sharing assistance, create a temporary state reinsurance and affordability program, expand rate review rules, and require some employers to refer full-time employees to health coverage navigators.
If you are eligible, you could have the option to enroll in a Medicare Part E plan through an exchange or through an employer. The bill would also change how certain marketplace subsidies are calculated. For people enrolled in traditional Medicare, the new cost-sharing limit would apply to covered Part A and B costs; it would not count noncovered services or certain extra charges. Some employees whose employers do not offer affordable coverage with required minimum value would be referred to a navigator.
The bill provides $2 billion for plan startup costs in fiscal year 2026 and authorizes funds for initial claims reserves. It appropriates $30 billion for a state reinsurance and affordability program for fiscal years 2026 through 2028, and authorizes funding for navigator capacity. Part E premiums must be set to cover the plans’ benefit and administrative costs.
No publicly available information.
No publicly available information.