New Health Options Act of 2025

This bill aims to lower health insurance costs and help people find better value care. It sets up a backup fund (a “reinsurance” program) to help insurers pay very large claims, which is meant to reduce premiums for certain individual plans. From 2026–2030, the fund gets up to $6 billion a year, based on enrollment, and unused money can roll forward; the money cannot be used for certain services named in existing law. In 2026, the program would cover 90% of claim costs between $110,000 and $300,000, with the health department allowed to adjust amounts to stay within the budget.

Insurers could choose to place some individual plans in a separate risk pool rather than the current single pool, but marketplace “qualified health plans” are not allowed to opt out. Starting in 2026, those separate plans could charge older adults more than today’s federal age-based limit, while marketplace plans must keep the current 3-to-1 age cap. Plans that opt out can still be paired with individual coverage HRAs (employer-funded reimbursement accounts) .

The bill also tries to steer patients to lower-cost care. If you go to a provider that’s out of network and the price is at or below a set low-price benchmark, you can choose to have what you paid count toward your in-network deductible and out-of-pocket maximum. Plans must share those benchmark numbers with enrollees, starting in 2026. Beginning in 2026, hospitals and doctors must also tell you if your copay or coinsurance would cost more than simply paying the provider’s cash price. If a provider fails to do this and you’re harmed, you can sue in federal court for an order to fix it and for damages allowed under your state’s law.

Key points

• Who is affected: People with individual health insurance, insurers, doctors and hospitals, and some employer reimbursement arrangements (ICHRAs).
• What changes: New reinsurance to lower premiums; some individual plans can use a separate risk pool and looser age-rating rules; marketplace plans keep today’s age cap; out-of-network low-price spending can count toward in-network limits; plans and providers must share price info; patients can sue providers for not disclosing when cash is cheaper .
• When: Most changes start January 1, 2026; reinsurance funding runs through 2030 .