Medicare currently limits how much doctors can charge patients: participating doctors must accept Medicare rates as full payment, and non-participating doctors can charge no more than 115% of Medicare rates. This bill creates a new contracting option where a Medicare patient and a physician can enter a written agreement setting their own payment terms, including fees above Medicare's standard rates. The patient can still file a Medicare claim and receive the standard reimbursement, but would personally owe any amount the doctor charges beyond that. State laws that cap physician charges would be preempted by this federal law, and dual-eligible individuals — those covered by both Medicare and Medicaid — are excluded from using this new contracting option.
Corporate Benefits
- Medicare fee-limit rules — Section 1848(g) charge limits removed for contracted services, enabling providers to bill above standard Medicare rates
Average Household Impact
- Patient out-of-pocket exposure — Contracted providers may charge above Medicare fee limits, with patients personally liable for the excess
- State charge-cap protections — Federal preemption removes state authority to limit physician fees for contracted Medicare services
Congressional Summary
Legalizing Premium Health Care Act of 2026This bill allows any Medicare beneficiary to enter into a contract with an eligible professional, regardless of whether the professional is participating in Medicare, for any item or service covered by Medicare.Such beneficiaries may submit a claim for Medicare payment in the amount that would otherwise apply, except that, where the professional is considered to be non-participating, payment shall be made as if the professional were participating. An eligible professional is a physician, physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, registered dietitian or nutrition professional, physical or occupational therapist, qualified speech-language pathologist, or qualified audiologist.A Medicare beneficiary must agree in writing in such a contract to (1) pay the eligible professional for a Medicare-covered item or service; and (2) submit, in lieu of the eligible professional, a claim for Medicare payment. However, a beneficiary may negotiate, as a term of the contract, for the eligible professional to file such claims on the beneficiary's behalf.The bill preempts state laws from limiting the amount of charges for physician and practitioner services for which Medicare payment is made.
Details
- Congress
- 119th
- Chamber
- Senate
- Status
- summarized
- Action
- Introduced in Senate
- Action Date
- 2026-05-20
- Date Added
- 2026-06-13
- Source
- Congress.gov →
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