Choose Medicare Act
Sponsored By: Representative Gomez
Introduced
Summary
Would create Medicare Part E public health plans to be offered in the individual, small group, and large group markets. These plans would be gold-level, cover essential health benefits and all Medicare items and services, and include abortion and other reproductive care that State law may not bar.
Show full summary
- Families and individuals would be able to enroll through Federal and State Exchanges, including the Small Business Health Options Program, gaining access to gold-level plans that include reproductive services.
- Employers and workers would be able to offer voluntary Part E plans in group markets beginning the first plan year that starts one year after enactment, with portability rules for employees who lose eligibility. Premiums would be set by the Secretary to fully finance benefits and administrative costs and must follow Affordable Care Act rating rules.
- Providers and regulators would face new rules on participation, payment, and oversight. Providers in Medicare on enactment would automatically join Part E networks, plans must pay in the aggregate at least Medicare rates but not exceed average Exchange issuer rates, and States plus the Secretary would have stronger rate-review and corrective-action powers including rate denials, modifications, rebates, civil monetary penalties, and possible loss of qualified health plan status.
*Includes a $2.0 billion appropriation for start-up funding in fiscal year 2026 and authority for additional initial reserve funding to cover early claims.*
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Bill Overview
Analyzed Economic Effects
10 provisions identified: 6 benefits, 1 costs, 3 mixed.
Cap on yearly Medicare cost-sharing
If enacted, Medicare would cap your yearly Part A and B cost-sharing. The cap would be $6,700 in 2027. After that, it would change each year by medical inflation, announced starting in 2026. Once you hit the cap, you would not owe more cost-sharing that year.
Bigger marketplace premium tax credits
If enacted, your premium tax credit would be based on a gold plan, not a silver plan. The old 400% income limit would be removed. A sliding percentage by income would set what you must pay. These rules would apply to tax years starting after December 31, 2025.
States get $30 billion to cut premiums
If enacted, states would get $30 billion for plan years starting in 2026–2028. States could run reinsurance or give other help to lower premiums or out-of-pocket costs. The funds would stay available until spent.
New Medicare Part E public option
If enacted, the government would offer Medicare Part E plans on the individual and group markets through the Exchanges. Plans would be gold level, cover essential benefits and Medicare-covered items, and include abortion and other reproductive services; states could not ban that coverage. Employers could choose to offer these plans starting one year after enactment, and the Secretary could act as a third‑party administrator. Premiums would be set to fully cover costs, and provider payment rates would be between Medicare rates and the average rates paid by other Exchange plans. The bill would provide $2 billion in FY2026 for start-up and allow extra reserves to pay claims in the first 90 days.
Lower deductibles on gold marketplace plans
If enacted, cost-sharing help would move to gold plans. Plans would pay 94% of costs at 100%–133% of poverty, 92% at >133%–150%, 90% at >150%–200%, 85% at >200%–300%, and 80% at >300%–400%. These rules would apply to plan years starting after December 31, 2025.
Stronger checks on health insurance rates
If enacted, states could use stronger rate review to protect consumers. The Secretary would consult with insurance commissioners and consumer groups and decide when federal action is needed. Actions could deny or change rates or require rebates. These rules must apply to plans by January 1, 2026.
More funding for coverage navigators
If enacted, the government could give grants to navigator groups to expand plan shopping and enrollment help. This authority would start at enactment. No fixed dollar amount is set.
Employers must refer workers to help
If enacted, employers with no plan, or a plan that is unaffordable or low value, would need to refer each full-time hire to a marketplace navigator or similar group. Current full-time workers would get a referral on the effective date. This would start in each state two years after enactment.
Small-group rating rules for large employers
If enacted, the premium rating limits used for small-group plans would also apply to large-group plans. The change would start with the first plan year that begins after enactment. Employers and insurers could see different pricing rules and limits.
Excise tax extended to Part E drugs
If enacted, some drugs subject to Part E price rules would also face an existing excise tax. The change would take effect on enactment. This mainly affects drug makers; any consumer price effects are uncertain.
Sponsors & CoSponsors
Sponsor
Gomez
CA • D
Cosponsors
Beyer
VA • D
Sponsored 6/11/2025
Huffman
CA • D
Sponsored 6/11/2025
McIver
NJ • D
Sponsored 6/11/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 6/11/2025
Moulton
MA • D
Sponsored 2/9/2026
Roll Call Votes
No roll call votes available for this bill.
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