Health Marketplace for All Act of 2025

Access to Group Coverage through Marketplace Pools: The bill allows entities meeting certain requirements to be deemed an employer, which enables them to offer group health plans or group insurance coverage to their members. (Section 2(a) and Section 736(a))

Protection Against Health-Based Membership Denial: Marketplace pools are prohibited from conditioning membership on any health status-related factor, including an individual's health status or that of an employee or dependent. (Section 736(b)(1)(B))

Flexible Drug Coverage Options: The legislation allows for health marketplace pools to offer drug coverage, including over-the-counter drugs, either alongside other benefits or as the only benefit offered by the plan or coverage. (Section 736(b)(5))

Coverage for Dependents: The bill allows group health plans or group health insurance coverage offered by the pool to be made available to dependents of members or employees of member entities. (Section 736(b)(2)(A)(ii))

Consistent Enrollment Rules: Rules of enrollment and reenrollment established by the pool must be applied consistently to all members and cannot be based on health status-related factors. (Section 736(b)(6)(C))

Potential for Coverage Limitations: The bill notes that a health insurance issuer or group health plan is not required to provide coverage outside of a specific service area and may still be able to undergo underwriting or exclude/limit coverage on an individual, subject to certain sections. (Section 736(b)(2)(B)(ii))

Variable Rates: The bill allows for rates established by the health marketplace pool or a contracting health insurance issuer to vary for individuals covered through the pool. (Section 736(b)(2)(A)(i))