Sponsors
The bill expands coverage options and consumer protections—notably a Medicare Buy‑In for 50–64 adults, broader premium tax credit eligibility, drug price negotiation, and market stabilization tools—while increasing federal fiscal obligations, creating affordability and market‑distortion risks for some consumers, and adding administrative and implementation complexity.
People with incomes above 400% of the federal poverty level (middle‑class families and higher‑earning individuals) will become eligible for premium tax credits, lowering their net marketplace premiums and reducing uninsured rates among that group.
Adults aged 50–64 who currently lack Medicare (uninsured and near‑elderly adults) gain a new Medicare Buy‑In option offering comprehensive Part A/B/D coverage, access to MA–PD plans, and outreach/enrollment support, expanding access to coverage before age 65.
Eligible Medicare Buy‑In enrollees receive a standardized, community‑rated supplemental option with limited cost‑sharing (covering Part A/B deductibles/copays with a $100 annual deductible) and defined enrollment periods, reducing out‑of‑pocket costs and protecting people with pre‑existing conditions.
Taxpayers and federal budgets face substantially higher spending risk because expanding premium tax credits, broadening Medicare benefits, creating a Buy‑In, funding reinsurance/risk corridors, and new demonstrations increase federal obligations and could raise the deficit or require offsets.
Unsubsidized consumers and some enrollees could see higher premiums or fee pass‑throughs as insurers and plans adjust pricing to new subsidies, program fees, or reinsurance financing, shifting costs to middle‑class families and those without subsidies.
People buying into the 50–64 Medicare option may face high, actuarially set premiums, age/geography rating differences, and steep late‑enrollment surcharges (up to 100%), making the Buy‑In unaffordable or risky for some intended beneficiaries.
Based on analysis of 10 sections of legislative text.
Deletes the 400% FPL cap on premium tax credits, creates a Medicare buy‑in for ages 50–64 and a direct Medicare supplemental option, allows HHS to negotiate Part D prices, and establishes reinsurance and risk corridors.
Introduced March 12, 2026 by S. Raja Krishnamoorthi · Last progress March 12, 2026
Removes the 400% of FPL cap on Affordable Care Act premium tax credits and replaces the current applicable-percentage table with a sliding scale; creates a federal Medicare "buy-in" option that lets adults ages 50–64 enroll in Medicare-like coverage; creates a new voluntary direct Medicare supplemental option to cover cost-sharing for existing Medicare beneficiaries; gives HHS authority to negotiate prices for Part D drugs charged to Part D plan sponsors and MA–PD organizations; and establishes a federal individual-market reinsurance fund plus an extended risk-corridor authority for insurers. The bill also allows Medicare demonstrations to include the new buy-in cohort and repeals a prior set of reconciliation health provisions. The changes take effect on a staggered schedule (tax changes apply to taxable years after 2026; the direct supplemental program phases in in 2027–2028; drug negotiation and some market reforms phase in for plan years starting in 2029), create new trust accounts to collect premiums, and give the HHS Secretary wide administrative and pricing authority to set premiums, negotiate drug prices, and administer reinsurance and risk-corridor programs.