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Bill

S 4583

Legalizing Premium Health Care Act of 2026

119th Congress Introduced by Lisa Murkowski and 1 co-sponsor

Medicare beneficiaries could sign written contracts with eligible professionals for covered services, enabling Medicare payment as if participating while preserving contract terms

Introduced in Senate
0
WeVote Research Nonpartisan
Bill Summary · S 4583

Summary of Bill: S. 4583 – Legalizing Premium Health Care Act of 2026

Purpose and overall goal

S. 4583 aims to create a new Medicare payment option that permits Medicare beneficiaries to contract directly with eligible professionals for Medicare-covered items and services. Under this framework, beneficiaries can pay or have payments handled under a written contract, with the physician or professional paid as if they were participating in Medicare, even if they are non-participating. At the same time, beneficiaries retain the ability to use their traditional Medicare benefits for covered services.

Key provisions and changes

  • Freedom of choice and contracting (Medicare Title XVIII):

    • Establishes a right for Medicare beneficiaries to enter into written contracts with eligible professionals (whether participating or non-participating) for any covered item or service.
    • Under such contracts, beneficiaries may submit claims to Medicare and receive payment for covered services at amounts that would apply under standard Medicare rules. If the professional is treated as non-participating, payment is made as if they were participating.
    • Claims submitted under the contract do not cause the professional to become participating or non-participating, and standard participation status rules under Medicare would not apply to items/services under the contract.
    • Contracts must be in writing, signed by both parties, specify payment terms, and be established before any items or services are provided.
    • Beneficiaries are held harmless for charges beyond the contract amount during the contract period.
    • Contracts must include: the items/services covered, responsibilities for submitting claims, and acknowledgment that certain customary Medicare payment incentives (e.g., payment limits or incentives) do not apply to amounts charged or paid under the contract.
    • The contract can include a provision whereby the professional files claims on behalf of the beneficiary, and the beneficiary may assign payments to the professional.

  • Protections and disclosures:

    • The contract must explain the beneficiary’s financial responsibilities, claim submission obligations, and the absence of standard Medicare payment incentives for contract-covered amounts.
    • Excludes dual-eligible individuals (those eligible for both Medicare and Medicaid) from the general contract provisions.

  • Definitions:

    • Clarifies terms such as “Medicare beneficiary,” “eligible professional,” “emergency medical condition,” and “urgent health care situation” to govern the contract framework.

  • Conforming amendment:

    • Adjusts related Medicare enrollment/participation wording to align with the new contracting option.

  • Preemption of state laws:

    • Preempts state (and territorial) laws that would limit charges for services provided by an eligible professional under the Medicare contract framework. This aims to ensure uniform applicability of the contract-based pricing across states.

Who would be affected

  • Medicare beneficiaries seeking direct contract arrangements with eligible professionals for covered services.
  • Eligible professionals (including those who are non-participating) who enter into such contracts with beneficiaries.
  • States and the District of Columbia, Puerto Rico, and U.S. territories, due to preemption provisions on charge limits.

Procedural and timeline notes

  • Introduced in the Senate on May 20, 2026, by Senator Paul with Senator Murkowski as a co-sponsor.
  • Referenced to the Committee on Finance; no further action detailed in the text provided.
  • The bill explicitly provides transitional and definitional rules to implement the new contracting option and to reconcile with existing Medicare payment structures.

Potential impacts (policy implications)

  • Expands beneficiary choice by enabling direct pre-arranged contracts for Medicare-covered services.
  • Could alter traditional Medicare payment dynamics by treating contracted services with payment rules that resemble participating status for payment purposes, while preserving the contract terms for patient cost-sharing.
  • May lead to variability in out-of-pocket costs depending on contract terms and negotiation between beneficiaries and professionals.
  • Preemption of state-law limits on professional charges could standardize pricing but may raise concerns about cost-sharing oversight and beneficiary protections.
  • Dual-eligible individuals are excluded from these contract provisions, maintaining existing Medicaid considerations for those enrollees.

Compiled from official sources — confirm details with the bill’s official record.

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