Extended Health Subsidies and Stronger Fraud Protection in Health Care.
This Act extends and modifies enhanced premium tax credits for 2026, allowing more citizens, including those with higher incomes, to receive financial assistance for marketplace health insurance premiums. It also introduces strict penalties for agents and brokers committing fraud on the Exchanges and significantly increases transparency and accountability for Pharmacy Benefit Managers (PBMs) in Medicare Part D to potentially lower drug costs.
Key points
Financial Aid Extended: Enhanced health insurance subsidies are extended and expanded for 2026, covering individuals earning up to 1000% of the federal poverty line.
Anti-Fraud Measures: Imposes severe civil and criminal penalties on agents and brokers for providing false enrollment information and requires verification of consumer consent for coverage changes.
Drug Cost Transparency: New rules for PBMs in Medicare Part D require compensation to be based only on flat service fees, ensuring rebates and discounts are fully passed through to plans.
Enrollment Period Extended: The annual open enrollment period for 2026 health plans is extended until March 19, 2026.
Introduced
Additional Information
Print number: 119_HR_6575
Sponsor: Rep. Kiggans, Jennifer A. [R-VA-2]
Process start date: 2025-12-10