Summary

Creates a federal reinsurance program to lower health insurance premiums by paying part of high-cost claims from 2026–2030. It directs HHS to quickly set up rules and initial 2026 parameters and makes technical changes to how insurers set premiums. Gives people new protections starting in 2026: you can ask your plan to count some out‑of‑network bills toward your deductible and out‑of‑pocket limit when the charge meets defined benchmarks, and providers must tell you if your cost sharing would exceed the cash price. Patients harmed by a provider’s failure to disclose can seek an injunction in federal court and state‑law damages.

Key Points

• Creates a federal reinsurance program to lower premiums by covering part of high‑cost claims from 2026–2030.
• Directs HHS to issue setup rules and 2026 parameters within 120 days of enactment.
• Aligns insurer premium rules by adjusting single risk‑pool elections and age‑rating provisions.
• Lets enrollees ask plans to count certain out‑of‑network charges toward their deductible and out‑of‑pocket limit if the price meets set benchmarks.
• Plans must provide the two benchmark amounts used to assess out‑of‑network charges.
• Requires providers/facilities to disclose if a patient’s cost sharing would exceed the provider’s cash price for the same service.
• Gives harmed patients a private right of action for an injunction in federal court and state‑law damages.
• Most consumer-facing changes start Jan 1, 2026; reinsurance runs 2026–2030.

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