The "Choose Medicare Act" introduces new Medicare Part E public health plans , designed to be available across the individual, small group, and large group markets. These plans are mandated to be qualified health plans under the Affordable Care Act, providing essential health benefits, all benefits available under traditional Medicare, and gold-level coverage . A key provision ensures these plans cover abortions and all other reproductive services , explicitly preempting any state laws that would prohibit such coverage. Eligibility for Medicare Part E plans extends to any U.S. resident not already covered by Medicare, Medicaid, or CHIP. The Secretary is tasked with establishing options for employers to offer these plans voluntarily, and a process for individuals to maintain coverage if they lose employer-sponsored eligibility. Initial funding includes $2 billion for startup costs in fiscal year 2026 and additional sums for initial reserves, with a clarification that funds for reproductive health services are not restricted. The bill outlines a system for provider reimbursement, ensuring that existing Medicare providers are automatically included and establishing a process for others to join. Reimbursement rates will be negotiated to be no lower than Medicare rates and no higher than average private insurer rates on Exchanges, with balance billing limitations applied. Furthermore, the Secretary will apply drug price negotiation provisions, similar to those for traditional Medicare, to prescription drugs covered by Medicare Part E plans. Significant enhancements are made to the Affordable Care Act (ACA), including changing the benchmark for premium tax credits from the "second lowest cost silver plan" to the " second lowest cost gold plan ." The legislation also makes permanent the expanded eligibility rules and enhanced affordability percentages for premium tax credits. Similarly, cost-sharing reductions are enhanced by shifting their benchmark to the "gold level" and increasing the federal share of total allowed costs for eligible individuals across various income levels. To further improve affordability, the bill establishes a $30 billion Reinsurance and Affordability Fund for 2026-2028, enabling states to provide reinsurance payments to insurers or direct assistance to individuals in the individual market. It expands ACA rating rules to the large group market, removing previous exemptions. The legislation also strengthens federal and state authority to review and take corrective action against excessive, unjustified, or unfairly discriminatory health insurance rates, including applying these rate review provisions to grandfathered health plans starting in 2026. Finally, the bill introduces an annual out-of-pocket limit for traditional Medicare beneficiaries (Parts A and B), starting at $6,700 in 2027 and indexed annually, to protect against high healthcare costs. It also amends the Fair Labor Standards Act to require employers not offering affordable, minimum-value health plans to refer full-time employees to ACA navigators, and authorizes appropriations to support navigator programs.