The MediKids Act expands Medicaid eligibility to cover children and young adults up to age 26, regardless of their immigration status, and establishes a system for automatic enrollment of newborns that allows parents to opt out if other qualifying health coverage is available. The bill ensures that states provide full federal funding for these expanded groups and extends specific pediatric health services, such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), to individuals up to age 26. Additionally, the legislation modifies tax rules to prevent this new Medicaid coverage from counting as minimum essential coverage for the purpose of individual health insurance tax penalties.
The Cancer Drug Parity Act of 2026 requires group health plans and insurance coverage to treat the cost-sharing for oral cancer medications no less favorably than that for intravenously administered cancer drugs. This rule applies to FDA-approved oral cancer treatments that a treating physician deems medically necessary and clinically appropriate, ensuring that deductibles, copayments, and coinsurance rates are not higher for oral options. The legislation also prohibits plans from making changes that would increase out-of-pocket costs or impose stricter limitations on oral cancer drugs compared to injected ones, while still allowing for standard utilization controls like prior authorization. Additionally, the bill mandates a Government Accountability Office study within two years to assess the impact of these changes on patient costs and access.
The TRUTH in Coverage Act of 2026 requires group health plans and health insurance issuers that cover gender-affirming procedures to also cover medical services intended to treat physical and psychological complications resulting from those procedures. This mandate applies regardless of whether the original gender-affirming treatment was covered by the plan and ensures that any required follow-up care faces the same cost-sharing rules and limitations as standard medical benefits. The bill defines "sex-rejecting procedures" broadly to include hormone therapy, surgeries, and puberty blockers, while explicitly excluding treatments for intersex conditions, life-threatening emergencies, and standard puberty suppression for early puberty. These provisions would take effect for plan years beginning on or after January 1, 2027, affecting individuals with access to employer-sponsored or individual health insurance.
The Expanding Opportunities for Recovery Act of 2026 directs federal funding to states to improve access to opioid addiction treatment for individuals who lack health insurance or face coverage barriers. These grants must be managed by state substance abuse agencies and used to provide evidence-based services, such as medication-assisted treatment, based on medical recommendations. The legislation explicitly limits grant funds to cover no more than 60 consecutive days of treatment per person and requires states to report data on treatment outcomes and usage. Additionally, the bill mandates that the federal government evaluate the program's effectiveness and share results publicly while offering technical assistance to participating states.
The Medicare-X Choice Act of 2026 creates a new public health plan called the Medicare Exchange health plan, which would be available to individuals and small groups starting in 2028. The bill establishes two dedicated funds to finance the plan's creation and technology updates, appropriating $1 billion each for fiscal year 2027. Under the plan, the government would set premiums to cover full costs, and reimbursement rates for doctors and hospitals would generally match current Medicare rates, with potential increases for rural areas. The legislation also requires health care providers who participate in traditional Medicare to also accept patients in this new plan, while prohibiting insurers from placing additional restrictions on enrollees. Additionally, the bill expands tax credits for people buying insurance, fixes the "family glitch" that currently limits subsidy eligibility for some workers, and authorizes the government to negotiate prices for prescription drugs.
The Cure Hepatitis C Act of 2026 establishes a federal program to eliminate hepatitis C by creating a subscription model that allows the government to purchase antiviral drugs directly from manufacturers and distribute them at no cost to specific patient groups. These groups include individuals in Medicaid or CHIP programs, those without health insurance, patients in correctional facilities, and those receiving care through the Indian Health Service. The bill also expands Medicare coverage by removing deductibles and copayments for hepatitis C treatments between 2028 and 2032. To support these efforts, the legislation authorizes funding for state grants to improve screening and treatment access, mandates the creation of a national strategy and performance dashboard, and requires coordination with various federal agencies and stakeholders.
The Medicare Advantage MLR Transparency Act requires insurance companies offering Medicare Advantage plans to publicly disclose detailed financial data starting in 2029. Under this bill, each plan must report how much total revenue it collects and specifically how much is spent on actual medical claims versus administrative overhead costs. The law also mandates that this financial information be presented in a consumer-friendly format and aligns the way benefits are displayed with standards used by other health insurance plans. These changes aim to give Medicare beneficiaries clearer insight into how their premiums are utilized by the plans they choose.
This bill requires hospitals, laboratories, imaging centers, and ambulatory surgical centers to publicly post detailed price lists for their services, including standard charges, negotiated rates, and discounted cash prices, starting in 2027. It also mandates that private health insurance plans provide consumers with cost-sharing estimates and publish quarterly data on payment rates to doctors and pharmacies beginning in 2029. Additionally, the legislation requires Medicare Advantage and prescription drug plan sponsors to report ownership details for providers and pharmacies they control, while establishing civil penalties for entities that fail to comply with these transparency rules.
The Preserving Patient Access Act requires health insurance plans to grant special enrollment periods when they remove a doctor from their network or stop covering a specific prescription drug that a patient has used recently. Under this bill, Medicare Advantage and individual market plans must allow individuals to join or switch plans within the same year if their current provider becomes out-of-network after a visit within the last two years or if a covered medication is dropped from the formulary within the last six months. These protections apply to both Medicare Advantage plans and private individual market plans, ensuring that patients can maintain access to their preferred doctors and medications without waiting for the annual open enrollment window. The changes are scheduled to take effect for plan years beginning on or after January 1, 2027.
The No Medicare Clawbacks Act of 2026 prevents group health plans from taking back money they have already paid for medical services if a patient later becomes eligible for Medicare benefits. This rule applies specifically when the medical care was provided during a period of retroactive Medicare coverage and the patient was current on their required health plan contributions at the time of service. By amending the Social Security Act, the bill ensures that individuals do not face financial penalties for receiving care before their Medicare eligibility is officially recognized. The legislation directly affects employers offering group health plans and their employees who might otherwise face recouped payments due to delayed Medicare enrollment.
