Medicare Cost Cap Act of 2026

Out-of-Pocket Cost Protection: Beneficiaries enrolled in Medicare Part A or Part B will not be responsible for additional out-of-pocket cost-sharing once they reach the annual out-of-pocket limit (Section 2(a)).

Predictable Annual Limits: The annual out-of-pocket limit will be set at $5,000 for 2028 and adjusted annually based on average per capita aggregate expenditures (Section 2(a)).

Improved Program Alignment: The bill aligns eligibility criteria for the Low Income Subsidy (LIS) and the Medicare Savings Program (MSP) to 200 percent of the poverty line starting in 2028 (Section 3(a) and 3(b)).

Simplified Enrollment: The bill eliminates resource standards for eligibility and enrollment determinations for LIS and MSP prior to January 1, 2028 (Section 3(a)).

Automated Benefits Processing: States are required to treat certain transmitted data as applications for the Medicare Savings Program, allowing for prompt treatment of eligible individuals (Section 3(c)).

Exclusions from Cost-Sharing Protection: Expenses for items and services that are not covered under Part A or B are not considered part of the out-of-pocket cost-sharing calculation (Section 2(a)).

Provider Charge Limitations: If an item or service is not furnished on an assignment-related basis, additional expenses incurred above the amount for an assignment-related service are not included in the out-of-pocket cost-sharing determination (Section 2(a)).