IdahoH 09292026 regular legislative sessionHouseWALLET

HEALTH CARE – Adds to existing law to establish provisions regarding certain out-of-pocket payments for health care services.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 1 benefits, 0 costs, 1 mixed.

Pay cash for covered care

Beginning 2027-01-01, your insurer cannot stop a provider from offering you a discounted cash price for a covered service. You may choose to pay the provider directly instead of filing a claim. If the provider accepts your discounted cash payment, it is payment in full. The provider cannot bill you or your plan for any remaining balance.

Cash payments count toward deductible

Beginning 2027-01-01, your cash payment for a covered, medically necessary service can count toward your deductible and yearly out-of-pocket limit. This applies only when you negotiate a price below the plan’s allowed amount and you pay out of pocket. You must send documents electronically: the service and provider details, the final bill, the negotiated cost, proof you paid, and proof the provider will not file a claim. When your insurer gets these, it must count the full amount you paid. Payments count toward in-network or out-of-network limits based on the provider’s network status. Amounts only count within the current plan period and do not carry over. Some coverages are excluded, including Idaho Medicaid, Medicare supplement policies, dental- or vision-only plans, workers’ compensation, motor-vehicle medical payments, most long-term care, and short-term policies of six months or less. Prior authorization, medical-necessity, and other utilization rules still apply.

Sponsors & Cosponsors

Sponsor

WAYS AND MEANS COMMITTEE
Affiliation unavailable

Cosponsors

Erin M. Bingham
Republican • House
Kevin Cook
Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 78 • No: 26

House vote • 3/30/2026

House Floor Vote

Yes: 29 • No: 5

House vote • 3/20/2026