New Health Options Act of 2025

The "New Health Options Act of 2025" seeks to amend the Patient Protection and Affordable Care Act by establishing a new federal reinsurance program. Administered by the Secretary of Health and Human Services, this program will provide payments to health insurance issuers for eligible individuals in specific off-exchange plans, aiming to lower their premiums. Funded at $50 per member month, capped at $6 billion annually from 2026 to 2030, the program explicitly excludes coverage for abortion services. A significant provision allows health insurance issuers to opt out of the ACA's single risk pool for certain individual health insurance coverage, forming separate risk pools for these plans, though Qualified Health Plans cannot opt out. For these opt-out plans, the bill removes the existing 3:1 age premium variation limitation , permitting actuarially justified age-based premium adjustments for adults. Furthermore, the bill introduces new consumer protections and transparency measures. Group health plans and issuers must allow individuals to apply certain out-of-network costs towards their deductibles and out-of-pocket maximums if the charge meets specific criteria. Healthcare providers and facilities will also be required to disclose to patients whether their insurance cost-sharing exceeds the charge for an uninsured individual, with provisions for civil action if this disclosure is violated. These changes are slated to begin for plan years on or after January 1, 2026.