Choose Medicare Act

This proposal would create a new public health insurance option called Medicare Part E. It would be sold on the federal and state health insurance marketplaces and could also be offered by employers, and most U.S. residents who are not on Medicare, Medicaid, or CHIP could enroll. It would cover the ACA’s essential health benefits plus all services covered by Medicare, provide higher-coverage “gold” benefits, and include abortion and other reproductive services; states could not block that coverage. Doctors and hospitals that already take Medicare would participate, the government would negotiate payment rates to fall between standard Medicare and typical marketplace rates, and workers could keep this coverage if they lose their job. The bill also provides startup funds in 2026 to launch the plan and allows those funds to be used for reproductive health services.

It aims to lower costs and strengthen protections:

• More help paying premiums: tax credits would be based on a gold plan instead of a silver plan, and the eligibility rules are made permanent, starting in 2026.
• Lower deductibles and copays: gold plans would cover about 80% to 94% of costs for people with incomes up to 4 times the poverty line, beginning for plan years after 2025.
• A cap on what people in traditional Medicare pay out of pocket: no more than $6,700 in 2027, adjusted each year for medical inflation.
• A fund to cut premiums and other costs: $30 billion for states (2026–2028) to run reinsurance or reduce out-of-pocket costs on the marketplaces.
• Stronger oversight of premium hikes: regulators could deny or reduce excessive or unfair rates or require rebates; these protections apply broadly, including to older “grandfathered” plans by 2026.
• Extends standard pricing protections to large employer plans, starting the first plan year after the law takes effect.
• Employers that don’t offer coverage, or offer coverage that is unaffordable or too skimpy, must refer full-time workers to marketplace navigators who can help them enroll; this starts two years after the law takes effect, with added navigator funding.
• It also states support for full coverage of reproductive services and ending restrictions in private insurance.