S-5672 — Patients First Act of 2026

YourVoice.Now Summary

Your MoneyCorporate BenefitsTransparency & AccountabilityTargeted & Unrelated ProvisionsCivil Liberties

Original Medicare patients could get many primary care visits with no copay in 2027–2031, and doctor fee raises would track medical costs.

Your Money

Your share of doctor bills — fee raises tied to costs from 2027

Today's law raises doctor fees 0.25 percent a year, or 0.75 percent for doctors in group payment plans. The bill would tie the raise to a medical cost index minus one point, and you usually pay 20 percent of each fee.

Primary care copays — none under a 2027–2031 Medicare plan

From 2027 through 2031, Medicare would pay a primary care practice a set fee each month for each patient who picks it. If it joins and you are not in a private Medicare plan, its visits, calls and emails would cost you nothing.

Advance approval for scans — Medicare requirement dropped

Today's law says doctors who rarely follow scan guidelines must get approval first. The bill would swap that rule for a study due in 2031, and scan bills would no longer need a guideline check to be paid.

Corporate Benefits

Outside-owned practices' Medicare bonuses — cut in half from 2032

A practice counts as outside-owned if an owner who is not a practitioner holds a share or runs its pay, staff, bills or prices. From 2032 it would get half the bonus others get, unless it has 15 or fewer practitioners.

Transparency & Accountability

Public comment required before Medicare ends a payment test

Medicare's office that tests new ways to pay would have to ask for public comment before it ends or changes a test. It would also have to list how much each test saved in its reports.

Medicare must publicly explain rejecting task force measure advice

Medicare would have to use a measure the task force backs unless it posts its reasons within 90 days. Each year it would post online what the task force asked for, the vote, and what Medicare did.

Pay cut for low doctor scores — top cut 9% to 2%

Medicare can now cut a doctor's pay by up to 9 percent for a low quality score. The bill would lower that top cut to 2 percent for 2027 through 2031, then raise it a point a year to 5 percent in 2034.

Doctor score accuracy — brand-new measures scored as perfect

From 2027, a doctor who reports on a brand-new measure, a recently changed one, or one with no benchmark would get the highest possible score on it. The score would not depend on how the doctor actually did.

Targeted & Unrelated Provisions

Doctor groups' control over Medicare quality measures — from 2032

A task force of up to 25 people, mostly practitioners and their trade groups, would pick the measures doctors are scored on. From 2032 Medicare could not use most measures the task force did not back.

Medicare quality registries limited to medical societies — from 2027

Starting in 2027, a group that sends doctors' quality data to Medicare would have to be run by a medical society led by practitioners. Its OK would last three years and could be renewed.

Civil Liberties

Medicare claims privacy — records shared with doctor registries by 2027

By 2027, doctor-run data groups could ask for Medicare claims records and link them to how patients did. They would skip the check other outside groups must pass, which reviews their methods and limits what they can report.

More about this bill

If you have Original Medicare, you could pay nothing for many primary care visits from 2027 through 2031. Family doctors, internists, and doctors for older adults or children could join a new payment plan. Nurse practitioners and physician assistants could join too. Medicare would pay them a set fee each month for each patient who picks them. Office and video visits, care planning, and phone or email advice would then have no copay or deductible. Practices with outside owners could not join unless they are small. Medicare's yearly raise in doctor fees would also grow. Today's law gives 0.25 percent a year, or 0.75 percent for doctors in group payment plans. From 2027, the raise would follow a medical cost index, minus one point. It could not drop below one-fourth of that index or go above three-fourths. Doctors in group plans would get half a point more. You usually pay 20 percent of a doctor bill, so your share would rise with the fee. Doctors in low-cost areas would keep a pay floor through 2031, with a boost in high-inflation years. Budget-balancing cuts could not move the fee rate more than 2.5 percent in one year. A third part would rework the score Medicare uses to raise or cut doctor pay. The most a low score could cut pay would drop from 9 percent to 2 percent from 2027 through 2031. It would climb back to 5 percent by 2034. In 2032 the program would be renamed POINTS and add a score for things like avoiding hospital stays. A task force led by practitioners would recommend what gets scored. Practices with outside owners would get half the bonus others get. Medicare would also drop its rule that some doctors get advance approval before ordering scans. Doctor-run research registries could ask for Medicare claims records starting in 2027.

Congressional Summary

Patients First Act of 2026 This bill modifies payments and incentive programs under the Medicare physician fee schedule. The bill establishes a temporary program to provide hybrid payments for certain primary care services. Under the program, payments for services relating to care management, behavioral health integration, office-based evaluation and management (including telehealth), and communications (e.g., phone calls) are made on a monthly basis to providers for each individual that is attributed to the provider's practice. The monthly amount is based on the national average amount for such services. Providers may opt into the model; in order to qualify, providers must be owned or controlled by health care practitioners and must have had the majority of their prior year's payments consist of payments for the covered services. The bill also renames the Merit-based Incentive Payment System (MIPS) and modifies the program to include performance measures relating to care efficiency (e.g., reducing avoidable hospitalizations). (MIPS is an incentive program under Medicare that allows health professionals to receive payment adjustments based on certain performance measures.) The bill generally reduces the program's performance-based payment adjustments, including positive adjustments for providers that are not owned or controlled by health care practitioners. Finally, the bill allows for larger annual adjustments to the Medicare physician fee schedule and bases these adjustments on inflation. It also requires certain corrections to compensate for expenditures under the fee schedule that exceed a certain amount in a given year, and it limits how much certain adjustment factors may vary each year.

Details

Congress: 119th
Chamber: Senate
Status: summarized
Action: Introduced in Senate
Action Date: 2026-09-30
Date Added: 2026-10-17
Source: Congress.gov →

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