H.R. 8840
Fair Care Act of 2026
Sponsor: Bruce Westerman · 0 cosponsors
Official summary
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Text of the bill
I Modernization of health savings accounts
A Modernization of health savings accounts and contributions
B Assistance to health savings accounts
II Improving Private Health Insurance
A Maintaining Protections for Patients with Preexisting Conditions
B Expanding Coverage Options
C Improving Commercial Health Insurance
III Competition, Transparency and Accountability
A Provider and Insurer Competition
B Price Transparency
C Prescription Drug Competition and Innovation
D Prescription Drug and Pharmacy Benefit Manager Transparency
E Medicare and Medicaid Prescription Drug Reforms
F Medical Malpractice Reform
IV Medicare and Medicaid Reforms
A Medicaid Reforms
B Medicare Reforms
C Medicare Choice and Competition
(a) In general. Part E of title XVIII of the Social Security Act, as added by section 251, is amended by adding at the end the following:
2 Out-of-Pocket limit
1860E–21. Out-of-pocket limit
(a) In general. Beginning with 2026, in the case of a Medicare enrollee, if the amount of the out-of-pocket cost-sharing of such enrollee for a calendar year equals or exceeds the catastrophic limit under subsection (b) for that year—
(1) the enrollee shall not be responsible for additional out-of-pocket cost-sharing incurred during that year; and
(2) the Secretary shall establish procedures under which the Secretary shall, in appropriate part from the Part A Medicare FFS Account under section 1817 and the Part B Medicare FFS Account under section 1841—
(A) pay on behalf of the enrollee the amount of the additional out-of-pocket cost-sharing described in paragraph (1) attributable to deductibles and coinsurance described in subsection (c)(1); and
(B) reimburse the enrollee the amount of the additional out-of-pocket cost-sharing described in paragraph (1) attributable to deductibles and coinsurance described in subsection (c)(2).
(b) Catastrophic limit. The amount of the catastrophic limit under this subsection for a year shall be the dollar amount in effect under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986 for self-only coverage for taxable years beginning in such year.
(c) Out-of-Pocket cost-Sharing defined. In this section, the term out-of-pocket cost-sharing means, with respect to an individual, the amount of costs incurred by the individual that are attributable to—
(1) deductibles and coinsurance imposed under part A or part B; and
(2) deductibles and coinsurance imposed under standard prescription drug coverage pursuant to section 1860D–2(b) or alternative prescription drug coverage pursuant to section 1860D–2(c) offered by a prescription drug plan.
(b) Application of out-of-Pocket limit to MA–PD plans
(1) In general. Section 1852(a)(1)(B) of the Social Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is amended—
(A) in clause (i), by striking clause (iii) and inserting clauses (iii) and (vi); and
(B) by adding at the end the following new clause:
(vi) Out-of-pocket limit. The provisions of section 1860E–21— In applying subsection (b) of section 1860E–21 pursuant to the previous sentence, an MA–PD plan may substitute a dollar amount that is less than the dollar amount specified under such subsection.
(I) shall apply to individuals enrolled under an MA–PD plan in the same manner as such provisions apply to Medicare enrollees under such section, except that in lieu of the application of subsection (a)(2) of such section the MA–PD plan shall establish procedures to provide for payment of any additional out-of-pocket cost-sharing described in subsection (a)(1) of such section incurred by individuals enrolled under the MA–PD plan; and
(II) as applied under subclause (I), may not be waived by application of this subparagraph.
(2) Exempting MA–PD plans offering alternative prescription drug coverage from part D deductible and out-of-pocket limit requirements. Section 1860D–2(c) of the Social Security Act (42 U.S.C. 1395w–102(c)) is amended—
(A) in paragraph (2), by striking The deductible and inserting In the case of a prescription drug plan, the deductible; and
(B) in paragraph (3), by striking The coverage provides and inserting In the case of a prescription drug plan, the coverage provides.
(c) Prescription drug plans required To report enrollees’ out-of-Pocket cost-Sharing. Section 1860D–12(b) of the Social Security Act (42 U.S.C. 1395w–112(b)) is amended by adding at the end the following new paragraph:
(7) Out-of-pocket cost-sharing reports. Each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall require that, with respect to each claim submitted for items or services furnished to an individual enrolled under the plan pursuant to the contract, the sponsor submits to the Secretary information on the amount of out-of-pocket cost-sharing (as defined in section 1860E–23(c)) applicable to such enrollee for such items or services.
(d) Conforming amendments
(1) Section 1813 of the Social Security Act (42 U.S.C. 1395e) is amended—
(A) in subsection (a), by inserting Subject to subpart 2 of part E: before paragraph (1); and
(B) in subsection (b), by inserting Subject to subpart 2 of part E: before paragraph (1).
(2) Section 1833 of such Act (42 U.S.C. 1395l) is amended—
(A) in subsection (a), in the matter preceding paragraph (1), by inserting and subpart 2 of part E after succeeding provisions of this section;
(B) in subsection (b), in the first sentence, by striking Before applying and inserting Subject to subpart 2 of part E, before applying;
(C) in subsection (c)(1), in the matter preceding subparagraph (A), by inserting subject to subpart 2 of part E, after this part,;
(D) in subsection (f), by striking In establishing and inserting Subject to subpart 2 of part E, in establishing; and
(E) in subsection (g)(1), by inserting and subpart 2 of part E and paragraphs (4) and (5).
(3) Section 1882(a)(2) of such Act is amended by striking No medicare and inserting Subject to section 1860E–24(c), no medicare.
D Telehealth Improvements and Expansion