The "Choose Medicare Act" introduces new Medicare Part E public health plans, which will be available in the individual, small group, and large group markets. These plans are designed to be qualified health plans under the Affordable Care Act (ACA), providing essential health benefits, all benefits covered by traditional Medicare, and gold-level coverage. A key provision mandates that these plans must cover abortions and all other reproductive services, explicitly preempting state laws that would prohibit such coverage.

Eligibility for Medicare Part E plans extends to U.S. residents not currently enrolled in Medicare, Medicaid, or CHIP. The Secretary of Health and Human Services will set premium rates to fully finance costs and negotiate provider reimbursement rates, ensuring they are not lower than Medicare rates nor higher than average Exchange rates. The bill also appropriates $2 billion for startup funding and additional sums for initial reserves, clarifying that funds for reproductive health services are exempt from federal restrictions.

The legislation makes substantial enhancements to the Affordable Care Act. It changes the benchmark for premium tax credits from the second-lowest cost silver plan to the second-lowest cost gold plan and permanently removes the 400% federal poverty level income cap for eligibility. Furthermore, it expands and increases cost-sharing reductions, allowing more individuals to qualify for greater assistance in reducing their out-of-pocket expenses.

To stabilize the individual health insurance market, the bill establishes a Reinsurance and Affordability Fund, appropriating $30 billion for fiscal years 2026-2028. This fund will provide states with resources for reinsurance payments to health insurance issuers or direct assistance to individuals to lower out-of-pocket costs. The bill also expands ACA rating rules to apply to the large group market, ensuring greater consumer protection across more plans.

For traditional Medicare beneficiaries, the bill introduces an annual out-of-pocket limit, starting at $6,700 in 2027 and indexed thereafter, protecting individuals from catastrophic health care costs. Once this limit is met, beneficiaries will not be responsible for further cost-sharing. Additionally, the bill strengthens federal and state authority to review and take corrective actions against excessive, unjustified, or unfairly discriminatory health insurance rates, extending these protections to grandfathered health plans.

Finally, the bill amends the Fair Labor Standards Act to require employers not offering affordable, minimum-value health plans to refer full-time employees to ACA Exchange navigators. It also includes a Sense of Congress that the federal government should model comprehensive reproductive services coverage and that all restrictions on such services in private insurance should end.