Medicare-X Choice Act of 2026
Sponsored By: Representative Craig, Angie [D-MN-2]
Introduced
Summary
Creates a new public Medicare-style health plan available through the ACA exchanges. It pairs a government-backed plan option with big changes to premium tax credits, provider payments, and drug pricing rules.
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- Families: Removes the 400% of Federal Poverty Level cap on premium tax-credit eligibility and adds a recapture cap of $5,000, while fixing the "family glitch" so more family members can qualify for help.
- Enrollees: The Medicare Exchange plan will be offered nationwide in the individual and small-group markets beginning plan year 2028, available in silver and gold versions, and must cover primary care with no cost-sharing.
- Providers and markets: Providers are generally paid at Medicare Part A and B rates with up to a 50% boost allowed in rural areas; the Secretary may negotiate drug payments, and a nationwide reinsurance pool is funded with $10 billion each year for high-cost cases.
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Bill Overview
Analyzed Economic Effects
9 provisions identified: 7 benefits, 0 costs, 2 mixed.
Bigger premium tax credit for families
If enacted, the bill would rewrite the premium tax credit rules for tax years starting after December 31, 2026. The affordability test would use 9.5% of household income for both self-only and family coverage, fixing the family glitch. The credit could apply above 400% of the federal poverty level and a new $5,000 recapture cap would limit repayments for incomes 400% and up.
Funds for antitrust enforcement
If enacted, the bill would authorize annual funding for DOJ and the FTC to study health care markets and enforce antitrust laws. It would provide $50 million per year to DOJ and $100 million per year to the FTC for each of fiscal years 2027 through 2031. Both agencies must report to Congress on funded activities and findings.
Funds and rules to start and run plan
If enacted, the bill would create a Plan Reserve Fund and a Data and Technology Fund in Treasury and seed each with $1 billion for fiscal year 2027. Those funds would accept appropriations through fiscal year 2036 to support plan setup, solvency, and premium analytics. The Secretary would have 180 days after enactment to issue required rules and 270 days to finalize them. Contracts running the program could not transfer insurance risk to contractors except for specified alternative payment models.
No change to current Medicare benefits
If enacted, the bill would state that nothing in this title affects benefits under Medicare (title XVIII) or the Medicare trust funds, including the Hospital Insurance and Supplementary Medical Insurance Trust Funds and the Medicare Prescription Drug Account. Current Medicare benefits and trust fund protections would remain unchanged.
How provider payments and premiums work
If enacted, most provider payments under the new plan would use rates like original Medicare. The Secretary could raise payments up to 50% for rural services. Prescription drug payments for the plan would be negotiated by the Secretary. The Secretary must set premiums to cover the plan's full actuarial cost, and premiums may vary by location and market.
National reinsurance to lower premiums
If enacted, the Secretary would set up a nationwide reinsurance pool to cover the very highest health costs not already pooled under the ACA. This is meant to lower individual-market premiums starting plan year 2028. The bill would provide $10 billion for each of fiscal years 2028, 2029, and 2030 to support the pool.
New Medicare Exchange health plan
If enacted, the bill would create a new Medicare Exchange health plan sold on the ACA Exchanges and SHOP starting plan year 2028. The plan would offer at least silver and gold versions and up to two versions per metal level. You could enroll only if you are an ACA "qualified individual" and not eligible for Medicare for the whole coverage period. The plan would cover primary care with no cost-sharing starting plan year 2028.
Payment, telehealth, and social supports
If enacted, the Secretary would be allowed to test and scale alternative payment models such as ACOs, bundling, or partial capitation starting plan year 2028. Telehealth and remote monitoring could be used when they reduce spending or improve quality without raising total spending. The Secretary could award grants to create accountable communities for health to link medical care with food, housing, transportation, and income supports when those links reduce spending, improve quality, or reduce disparities.
Provider rules that affect access
If enacted, providers would generally need to participate in the Medicare Exchange plan to remain enrolled in Medicare or to participate in State Medicaid plans, starting January 1, 2028. The Secretary must create a narrow opt-out process for exceptional circumstances where participation would threaten a provider's operation. The bill also requires processes for additional providers to join the plan.
Sponsors & CoSponsors
Sponsor
Craig, Angie [D-MN-2]
MN • D
Cosponsors
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 7/15/2026
Rep. Quigley, Mike [D-IL-5]
IL • D
Sponsored 7/15/2026
Roll Call Votes
No roll call votes available for this bill.
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