Legalizing Premium Health Care Act of 2026

Increased Freedom of Choice: Under Section 2(a)(1), any individual entitled to insurance benefits under title XVIII may obtain health services from any qualified institution, agency, or person that undertakes to provide those services.

Freedom to Contract: Section 2(b)(1) allows a Medicare beneficiary to enter into a contract with an eligible professional for any item or service covered under the title.

Consistent Payment Rates: According to Section 2(b)(2), when a beneficiary enters into a contract, they can submit a claim for payment, and the payment shall be made in the amount that would otherwise apply to such professional.

Protection from Unexpected Charges: Section 2(b)(3)(A)(i) states that a beneficiary shall be held harmless for any subsequent payment charged for an item or service in excess of the amount established under the written contract.

Flexibility in Claim Filing: Section 2(b)(3)(C) allows a beneficiary to negotiate a provision where the eligible professional files claims on behalf of the beneficiary with the Secretary and any supplemental insurance plan.

Exclusion of Dual Eligibles: Section 2(b)(3)(D) stipulates that the contracting provisions do not apply if a beneficiary is eligible for medical assistance under title XIX.

Contractual Responsibilities: Under Section 2(b)(3)(B)(i), the beneficiary must agree to be responsible for payment to the eligible professional for items or services under the terms and amounts established in the contract.

Claim Submission Burdens: Section 2(b)(3)(B)(ii) requires that the beneficiary agrees to be responsible for submitting claims under the title to the Secretary and any supplemental insurance plans, unless the contract provides otherwise.

Restrictions on Timing: Section 2(b)(3)(A)(iii) prohibits these contracts from being entered into at a time when a beneficiary is facing an emergency medical condition or an urgent health care situation.