To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.

Summary

Makes three major health-policy changes: temporarily narrows premium tax credit eligibility and adjusts the subsidy table for 2026–2027, tightens Medicare Advantage (MA) risk-adjustment rules and coding verification beginning in 2026, and imposes much stronger civil and criminal penalties plus a verification requirement for agents and brokers who submit incorrect or fraudulent enrollment information to exchanges. The bill also requires HHS to evaluate and correct coding differences between MA plans and traditional Medicare and to establish a broker verification process for federally run exchanges by January 1, 2028.

• Temporarily limits premium tax-credit eligibility and changes the subsidy percentage table for 2026–2027, reinstating a 400% income cap instead of 600%.
• Starts using two years of diagnostic data for Medicare Advantage risk adjustment beginning in 2026.
• Bans use of diagnoses from chart reviews and health risk assessments for MA payment-setting and requires HHS to verify such diagnoses.
• Requires HHS to annually evaluate and publicly report MA vs. traditional Medicare coding differences and to adjust payments to account for them.
• Creates negligent-conduct civil penalties for agents/brokers ($10,000–$50,000 per affected individual) for providing incorrect exchange information.
• Imposes civil penalties up to $200,000 per individual application and criminal penalties (up to 10 years imprisonment) for knowingly providing false enrollment information.
• Mandates a broker/agent verification process for federally operated exchanges by January 1, 2028 when agents/brokers are eligible for commissions.
• Does not include explicit new appropriations; implementation of evaluations and verification will rely on HHS administrative capacity or separate funding.
• Affects both marketplace enrollees (via tax credits) and Medicare Advantage program payments, so impacts consumers, insurers, and enrollment intermediaries.