New Health Options Act of 2025
Sponsored By: Representative Palmer
Introduced
Summary
Establishes a federally funded reinsurance program for off-exchange individual plans to reduce premiums and reshape how individual-market plans are priced and pooled. It also would change age-rating and single risk-pool rules, let certain out-of-network charges count toward in-network deductibles, and require providers to disclose lower prices.
Show full summary
- Families and consumers: People buying off-exchange plans would likely see lower premiums because the program pays a portion of very large claims. The changes apply to plan years beginning January 1, 2026.
- Insurers and market design: Issuers would face new rules on single risk-pool elections and could lose some age-based premium limits while qualified health plans must keep a 3-to-1 age rating cap.
- Providers and patients: Providers and facilities would have to disclose when a cash price is lower than a patient’s expected cost sharing. Harmed patients could sue for injunctive relief and damages under state law.
*This bill would increase federal spending by authorizing annual appropriations for the reinsurance program equal to $50 per member-month, capped at $6.0 billion per year for 2026 through 2030.*
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 0 costs, 1 mixed.
Five year reinsurance for off exchange plans
If enacted, the government would run a reinsurance program in 2026 through 2030 to help lower premiums for certain off-exchange individual plans. Each year it would fund $50 times total member months, up to $6 billion. HHS would set the rules within 120 days of enactment. For 2026, defaults would be: attachment point $110,000, payment share 90%, and a $300,000 cap. Funds could not pay for certain services named in current law.
Out-of-network credits and price disclosures
If enacted, starting January 1, 2026, you could choose to count what you pay an out-of-network provider toward your in-network deductible and out-of-pocket limit. This would apply only if the service is covered and the charge is at or below the plan’s lowest in-network recognized payment or the State’s 25th percentile price. Plans would have to share both reference amounts with enrollees. Providers would also need to tell you before care if your plan cost sharing would be higher than the cash price, and you could sue if they do not.
New age-based pricing and marketplace rules
Starting with plan years on or after January 1, 2026, marketplace Qualified Health Plans would still be limited to 3-to-1 age rating for adults. Plans that use the special election could not be sold as QHPs. For individual plans where the insurer uses that election, premiums could vary by age more than usual, and those enrollees would be treated as one risk pool.
Keep ICHRAs usable with individual plans
If enacted, agencies could not deny pairing an Individual Coverage HRA with your individual health plan just because the insurer made the single risk-pool election. This would take effect upon enactment. It would keep this option open for employers and workers.
Sponsors & CoSponsors
Sponsor
Palmer
AL • R
Cosponsors
Westerman
AR • R
Sponsored 11/25/2025
Davidson
OH • R
Sponsored 12/18/2025
Allen
GA • R
Sponsored 1/21/2026
Roll Call Votes
No roll call votes available for this bill.
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