Care Over Profits Act of 2026

This bill, titled the "Care Over Profits Act of 2026," seeks to reform health insurance practices by increasing the medical loss ratio (MLR) for health insurance coverage. Specifically, it raises the MLR from 80 percent to 85 percent for plans offered in the small group and individual markets. This change, effective for plan years beginning January 1, 2026, mandates that insurers spend a larger portion of premium revenue directly on medical care and quality improvement activities, rather than on administrative costs or profits. Additionally, the legislation introduces new penalties for agents and brokers involved in enrollment in qualified health plans through an Exchange. It imposes civil penalties ranging from $10,000 to $50,000 per individual for negligence or disregard in providing correct enrollment information. For knowingly and willfully providing false or fraudulent information, agents and brokers face more severe consequences, including civil monetary penalties of up to $200,000 per individual and potential criminal penalties , such as fines and up to 10 years imprisonment. These provisions, effective for applications for plan years beginning January 1, 2027, are designed to deter fraudulent enrollment practices and ensure the integrity of health plan marketplaces.