PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Palmer, Gary J. [R-AL-6] · R–AL
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Jan 22, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-03-03 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed New Health Options Act of 2025 would let insurers group certain individual health plans separately and create federal payments to help cover those plans’ claims, with the stated aim of lowering premiums. It would change age-based pricing rules for participating plans. People with health coverage could count certain lower-priced care outside their insurer’s network toward their in-network deductible and out-of-pocket limit. Providers would also have to tell patients when using their coverage would cost them more than the price charged to someone without coverage for that service.
This Act may be cited as the New Health Options Act of 2025.
There is established a Reinsurance Program, to be administered by the Secretary of Health and Human Services, to provide payments to health insurance issuers with respect to claims for eligible individuals for the purpose of lowering premiums for such individuals.
A health insurance issuer shall consider all enrollees in all health plans offered by such issuer in the individual market with respect to which such issuer has made the election described in subparagraph (A) to be members of a single risk pool.
by inserting or, in the case of such coverage with respect to which the issuer of such coverage has made the election described in section 1312(c)(1)(A) of the Patient Protection and Affordable Care Act, by more than an actuarially justified amount for adults before ; and.
at the option of such individual, apply such costs to any deductible or out-of-pocket maximum applicable to items and services furnished by health care providers or health care facilities with contracts in effect with such plan or issuer for the furnishing of such items or services, but only if the following requirements are met
whether the amount of cost sharing (including deductibles, copayments, and coinsurance) that would be incurred by such individual for such item or service under such plan, coverage, or program, as applicable, exceeds the charge that would apply for such item or service for an individual without benefits under any such plan, coverage, or program for such item or service.
Section 2 would establish a reinsurance program—federal payments to insurers toward covered claims—administered by the Secretary of Health and Human Services. Lower premiums are its stated purpose, not an outcome established by the text.
There is established a Reinsurance Program, to be administered by the Secretary of Health and Human Services, to provide payments to health insurance issuers with respect to claims for eligible individuals for the purpose of lowering premiums for such individuals.
The bill would appropriate money annually for 2026 through 2030 using a formula of $50 multiplied by the total months of coverage for eligible enrollees. Each year's appropriation could not exceed $6 billion.
for each year during the period beginning on January 1, 2026, and ending on December 31, 2030, there is appropriated out of any monies in the Treasury not otherwise obligated an amount equal to the product of $50 and the aggregate number of member months for all eligible individuals enrolled in a covered plan during such year.
In no year shall the appropriation for the Reinsurance Program authorized in paragraph (1) exceed $6,000,000,000.
Unused appropriations could pay claims in any future year. Thus, the end of annual funding in 2030 would not itself require all program payments to stop then.
Appropriated amounts remaining unexpended at the end of any year may be used to make payments under the Reinsurance Program in any future year.
for each year during the period beginning on January 1, 2026, and ending on December 31, 2030
Reinsurance eligibility would cover people enrolled in individual plans whose insurers choose the separate-pool option and that exclude services identified in section 1303(b)(1)(B)(i). Program funds also could not pay for those services. The bill refers to that provision as it exists on enactment but does not reproduce its description of the services.
The term covered plan means individual health insurance coverage (as such term is defined in section 2791 of the Public Health Service Act)— (i) with respect to which the issuer of such coverage has made the election described in section 1312(c)(1)(A); and (ii) that does not provide coverage for services described in section 1303(b)(1)(B)(i) (as in effect on the date of the enactment of this section).
The term eligible individual means an individual enrolled in a covered plan.
No funds received under the Reinsurance Program may be used to pay for services described in section 1303(b)(1)(B)(i) (as in effect on the date of the enactment of this section).
The Secretary would have to set program operating rules consistent with the bill. Within 120 days after enactment, the Secretary would have to establish enough rules to specify how the program would operate for 2026.
The Secretary shall establish parameters for the operation of the Reinsurance Program consistent with this section.
Not later than 120 days after the date of the enactment, the Secretary shall establish sufficient parameters to specify how the Program will operate for 2026.
For 2026, the bill would set a $110,000 attachment point, the claims threshold where reinsurance begins; a 90 percent payment share; and a $300,000 reinsurance cap, the upper claims threshold. The Secretary would set these parameters annually.
The Secretary shall annually establish an attachment point, payment proportion, and reinsurance cap with respect to claims for eligible individuals for payments under the Reinsurance Program
(A) The attachment point for the period beginning January 1, 2026, and ending December 31, 2026, shall be $110,000. (B) The payment proportion for the period beginning January 1, 2026, and ending December 31, 2026, shall be 90 percent. (C) The reinsurance cap for the period beginning January 1, 2026 and ending December 31, 2026, shall be $300,000.
The Secretary could adjust the payment parameters as necessary to keep annual program payments within the money available for that year.
The Secretary may adjust any amounts described in paragraph (1) as necessary to ensure the Reinsurance Program does not make payment for a year in excess of the amount available for such year under subsection (b).
Insurers could elect to exclude plans from the existing single-risk-pool rule. Each insurer would have to combine everyone enrolled in its elected individual-market plans into one separate risk pool—a group whose insurance risks are considered together.
by inserting and other than any health plan with respect to which such issuer has elected for this subparagraph not to apply after grandfathered health plans
A health insurance issuer shall consider all enrollees in all health plans offered by such issuer in the individual market with respect to which such issuer has made the election described in subparagraph (A) to be members of a single risk pool.
A plan could not meet the bill's amended requirements for a qualified health plan if its insurer elected the separate-pool option for that plan. The pool changes and this restriction would apply to plan years beginning on or after January 1, 2026.
Prohibiting single risk pool opt out for qualified health plans Section 1301(a)(1)(C) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)) is amended
(v) has not made the election described in section 1312(c)(1)(A) with respect to such plan.
The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2026.
For plans using the separate-pool option, the bill would insert an adult age-pricing limit based on an actuarially justified amount, meaning an amount supported by insurance risk calculations. This amendment would apply to plan years beginning on or after January 1, 2026. The existing pricing provision is not reproduced in full.
Section 2701(a)(1)(A)(iii) of the Public Health Service Act (42 U.S.C 300gg(a)(1)(A)(iii)) is amended by inserting or, in the case of such coverage with respect to which the issuer of such coverage has made the election described in section 1312(c)(1)(A) of the Patient Protection and Affordable Care Act, by more than an actuarially justified amount for adults before ; and.
The amendment made by subparagraph (A) shall apply with respect to plan years beginning on or after January 1, 2026.
The bill would expressly require qualified health plans that vary adult premiums by age to keep that variation within a 3-to-1 ratio: age alone could not produce a premium more than three times another adult's premium.
(D) with respect to the premium rate charged by such plan, if such plan varies such rate by age, does not vary such rate by more than 3 to 1 for adults (consistent with section 2707(c) of the Public Health Service Act).
The Health and Human Services, Labor, and Treasury Secretaries could not deny a plan eligibility for integration with an individual health care reimbursement arrangement solely because its insurer chose the separate-pool option. This addresses eligibility to pair coverage with a reimbursement arrangement; it does not remove other eligibility requirements.
The Secretaries of Health and Human Services, Labor, and the Treasury shall not fail to treat any individual health insurance coverage (as defined in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91)) as eligible for integration with an individual health care reimbursement arrangement on the basis that the health insurance issuer (as so defined) of such coverage has made the election described in section 1312(c)(1)(A) of the Patient Protection and Affordable Care Act (as inserted by subsection (b)).
Section 3 would require group health plans and insurers offering group or individual coverage, at an enrollee's request, to count qualifying out-of-network expenses toward the applicable in-network deductible or out-of-pocket maximum. These are the amount a patient must pay before certain benefits begin and the limit on the patient's own spending. The care must be a type for which the plan provides benefits and meet the bill's price test.
A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall, in the case that an individual enrolled under such plan or coverage is furnished items or services by a health care provider or health care facility that does not have in effect a contractual relationship with such plan or issuer for the furnishing of such items or services and such individual incurs any out-of-pockets costs with respect to such items and services, at the option of such individual, apply such costs to any deductible or out-of-pocket maximum applicable to items and services furnished by health care providers or health care facilities with contracts in effect with such plan or issuer for the furnishing of such items or services, but only if the following requirements are met
The item or service furnished by such provider or facility without a contract in effect with such plan or issuer is an item or service for which benefits are available under such plan or coverage.
The amount charged by such provider or facility for such item or service is equal to or less than
The out-of-network charge would have to be no more than either of two benchmarks: the plan's lowest recognized payment for that care among contracted providers in the same insurance rating area, or the statewide 25th percentile of charges for that care—the cutoff at the lower quarter of charges.
The amount charged by such provider or facility for such item or service is equal to or less than— (A) the lowest amount recognized by the plan or coverage as payment for such item or service out of all health care providers and health care facilities with a contract in effect with such plan or issuer to furnish such item or service in the same rating area (as defined for purposes of section 2701) in which the item or service described in paragraph (1) was furnished; or (B) the 25th percentile of charges for such item or service furnished in the same State in which the item or service described in paragraph (1) was furnished.
Plans and insurers would have to make both price benchmarks available to all enrollees for each covered item or service.
A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall, with respect to each item or service for which benefits are available under such plan or coverage, make available the lowest amount described in subsection (a)(2)(A) and the 25th percentile described in subsection (a)(2)(B) to all individuals enrolled under such plan or coverage.
The out-of-network expense-crediting and benchmark-disclosure requirements would apply to plan years beginning on or after January 1, 2026.
The amendment made by subsection (a) shall apply to plan years beginning on or after January 1, 2026.
Beginning January 1, 2026, section 4 would require providers and facilities to tell patients and prospective patients whether their deductible, copayment, and coinsurance costs for covered care would exceed the charge for someone without benefits for that care.
Beginning January 1, 2026, each health care provider and health care facility shall disclose to patients and prospective patients
being furnished or seeking to be furnished an item or service by such provider or facility for which benefits are available under such plan, coverage, or program, as applicable
whether the amount of cost sharing (including deductibles, copayments, and coinsurance) that would be incurred by such individual for such item or service under such plan, coverage, or program, as applicable, exceeds the charge that would apply for such item or service for an individual without benefits under any such plan, coverage, or program for such item or service.
The provider price-disclosure requirement would cover patients enrolled in group health plans, group or individual insurance, and federal health care programs under the cited statutory definition, expressly including the program established under chapter 89 of title 5.
enrolled in a group health plan, group or individual health insurance coverage, or a Federal health care program (as defined in section 1128B but including the program established under chapter 89 of title 5, United States Code)
A person harmed by a provider's or facility's violation of the price-disclosure rule could sue in federal district court. The person could seek a court order requiring or prohibiting conduct and damages equal to the amount available for that harm under the law of the state where the provider or facility is located. These remedies would be additional to other applicable penalties.
In addition to any other penalty applicable with respect to a violation of subsection (a), an individual who is harmed by a violation of this section by a health care provider or health care facility may bring an action against such provider or facility in an appropriate district court of the United States for— (1) appropriate injunctive relief; and (2) damages in an amount that is equal to the amount provided for such harm in a civil action under the law of the State in which the provider or facility is located.
The supplied actions snapshot, updated January 22, 2026, records introduction in the House on March 3, 2025, and referral that day to Energy and Commerce, Ways and Means, and Education and Workforce for provisions within their respective jurisdictions.
Source snapshot updated 2026-01-22T09:06:05Z.
2025-03-03: Introduced in House
2025-03-03: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2025-03-03. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No provision unrelated to the bill's health coverage, costs, and price-disclosure subject was identified in the supplied complete introduced text. This conclusion is limited to that version.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places outside a general program allocation was identified in the supplied complete introduced text. This conclusion is limited to that version and does not establish formal earmark status in accompanying materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow preferential benefit beyond the general policy's coverage and participation rules was identified in the supplied complete introduced text. This conclusion is limited to that version.
Full text preserved for this analysis. Legislative record snapshot: Jan 22, 2026. How PlainBill uses AI