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S3369119th CongressWALLET

Medicare-X Choice Act of 2025

Sponsored By: Senator Bennet, Michael F. [D-CO]

Introduced

Summary

Creates a new federally run "Medicare Exchange health plan" sold on ACA Exchanges that sets benefits, provider payments, and premiums across the individual and small-group markets. The plan must offer at least silver and gold options and cover primary care with no cost-sharing.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 3 benefits, 0 costs, 2 mixed.

Medicare benefits and trust funds

If enacted, the bill would state that nothing in this title would change Medicare benefits under title XVIII. It would also protect the Hospital Insurance and Supplementary Medical Insurance trust funds, including the Medicare prescription drug account.

Health and social service integration

If enacted, the bill would let HHS link medical care under the plan with food, housing, transportation, and income help when that integration reduces spending or improves quality. The Secretary could award grants to colleges, local agencies, nonprofits, and others to build community partnerships, run needs assessments, and develop data systems. The Secretary must also study adding long-term services, home and community care, assistive devices, and vision, hearing, and dental coverage. That study report would be due to Congress within two years of enactment.

Funding, data, and admin rules

If enacted, the bill would create two Treasury funds to support the plan. Congress would appropriate $1 billion to a Data and Technology Fund for FY2027 and $1 billion to a Plan Reserve Fund for FY2027, with amounts available until spent and funds consisting of amounts appropriated in fiscal years 2027 through 2036. The Chief Actuary at CMS would administer the Data and Technology Fund. The Secretary could collect premium and related data from State insurance officials under applicable privacy rules. The Secretary could hire contractors for administration but could not transfer insurance risk to contractors except for certain alternative payment models. HHS must publish implementing rules within 180 days and finalize them within 270 days of enactment.

New Medicare-style plan for Exchanges

If enacted, the bill would create a new Medicare Exchange health plan offered on the ACA exchanges starting plan year 2028. You could enroll only if you are an ACA "qualified individual" for the whole enrollment period and are not eligible for Medicare. The plan must offer at least silver and gold versions and no more than two versions per metal level. Premiums would have to cover full actuarial cost, could vary by area and market, and excess premium revenue could be carried forward. For 2028, premiums would be set per rating area using 2027 rates. After 2028, most enrollees in a State would be pooled in a single risk pool unless the State creates separate pools.

Provider and drug payment rules

If enacted, the bill would generally pay providers at rates like original Medicare for services covered by the new plan. The Secretary could raise some rural reimbursements by up to 50 percent where appropriate. Prescription drug payment rates for the plan would be negotiated by the Secretary. The Secretary would be able to use value-based, bundled, and other payment models and would require telehealth integration when it reduces spending or improves quality starting in plan year 2028.

Sponsors & CoSponsors

Sponsor

Bennet, Michael F. [D-CO]

CO • D

Cosponsors

  • Sen. Kaine, Tim [D-VA]

    VA • D

    Sponsored 12/4/2025

  • Sen. Booker, Cory A. [D-NJ]

    NJ • D

    Sponsored 12/4/2025

  • Sen. Duckworth, Tammy [D-IL]

    IL • D

    Sponsored 12/4/2025

  • Sen. Smith, Tina [D-MN]

    MN • D

    Sponsored 12/4/2025

  • Sen. Warnock, Raphael G. [D-GA]

    GA • D

    Sponsored 12/4/2025

  • Sen. Hickenlooper, John W. [D-CO]

    CO • D

    Sponsored 12/4/2025

  • Sen. Klobuchar, Amy [D-MN]

    MN • D

    Sponsored 12/4/2025

  • Sen. Peters, Gary C. [D-MI]

    MI • D

    Sponsored 12/9/2025

  • Sen. Slotkin, Elissa [D-MI]

    MI • D

    Sponsored 12/9/2025

  • Sen. Shaheen, Jeanne [D-NH]

    NH • D

    Sponsored 12/18/2025

Roll Call Votes

No roll call votes available for this bill.

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