H.R. 6494
Territories Health Equity Act of 2025
Official summary
Written by the Congressional Research Service.
Territories Health Equity Act of 2025
This bill alters provisions relating to the treatment of U.S. territories under Medicaid, Medicare, and Medicare Advantage.
For example, the bill
- eliminates Medicaid funding limitations for U.S. territories beginning in FY2026,
- exempts an individual from late-enrollment penalties for Medicare medical services if the individual resided in Puerto Rico as of the date of eligibility and the individual enrolls within five years of such date, and
- establishes minimum criteria for certain elements used in Medicare Advantage payment calculations for areas within U.S. territories.
The bill also allows residents of U.S. territories who are unable to obtain health insurance through their employer or a health insurance exchange to instead obtain coverage that is at least as broad as the coverage available to Members of Congress and their staff through the District of Columbia exchange.
Text of the bill
I MEDICAID
II MEDICARE
A Part A
B Part B
C Medicare Advantage (Part C)
D Part D
III MISCELLANEOUS
(a) In general. Not later than February 1, 2026, the Secretary of Health and Human Services shall submit to Congress a report that details the adverse impacts in each territory from the practical exclusion of the territories from the provisions of part II of subtitle D of title I of the Patient Protection and Affordable Care Act insofar as such provisions provide for the establishment of an American Health Benefit Exchange or the administration of a federally facilitated Exchange in each State and in the District of Columbia for the purpose of making health insurance more affordable and accessible for individuals and small businesses.
(b) Information in report. The report shall include information on the following:
(1) An estimate of the total number of uninsured and underinsured individuals residing in each territory with respect to health insurance coverage.
(2) A description of the number of health insurance issuers in each territory and the health insurance plans these issuers offer.
(3) An estimate of the number of individuals residing in each territory who are denied premium and cost-sharing assistance that would otherwise be available to them for obtaining health insurance coverage through an Exchange if they resided in one of the 50 States or in the District of Columbia.
(4) An estimate of the amount of Federal assistance described in paragraph (3) that is not being made available to residents of each territory.
(5) An estimate of the number of small employers in each territory that would be eligible to purchase health insurance coverage through a Small Business Health Options Program (SHOP) Marketplace that would operate as part of an Exchange if the employers were in one of the 50 States or in the District of Columbia.