Legalizing Premium Health Care Act of 2026

Key Points

• This bill lets Medicare patients sign private contracts with doctors to pay agreed-upon prices for covered services, even if those prices are higher than what Medicare normally allows. Patients can still submit claims to Medicare for partial reimbursement.
• Patients who sign these contracts can file claims with Medicare and get paid back at normal Medicare rates, but they are responsible for any charges above that amount. The doctor is treated as a participating provider for reimbursement purposes.
• Doctors in these private contracts are freed from Medicare's standard price caps and payment incentive rules for those specific services, allowing them to charge higher rates than Medicare would normally permit.
• Patient protections require that contracts be written and signed before care begins, must spell out all costs, and cannot be used during emergencies or urgent situations requiring care within 12 hours.
• People who have both Medicare and Medicaid (dual eligible individuals) are excluded from entering these contracts, protecting the lowest-income Medicare recipients from higher out-of-pocket costs.
• The bill overrides all state laws that cap how much doctors can charge for Medicare-covered services, removing an existing layer of consumer protection in states that have such limits.