This bill, titled the Medicare-X Choice Act of 2025, establishes a new public health plan, the Medicare Exchange health plan , to offer a coordinated and low-cost healthcare option. Beginning in plan year 2028, this plan will be available in all rating areas through the Affordable Care Act (ACA) exchanges for both individual and small group markets. It is designed for qualified individuals who are not eligible for traditional Medicare benefits. The plan will adhere to ACA Qualified Health Plan requirements, offering silver and gold level coverage, and importantly, will provide primary care services with no cost-sharing requirements . To support its establishment and operation, the bill creates a Plan Reserve Fund and a Data and Technology Fund, each initially appropriated $1 billion for fiscal year 2027. Premiums for the plan will be set to cover full actuarial and administrative costs, varying geographically, and will generally reimburse providers at Medicare fee-for-service rates, with the Secretary authorized to negotiate prescription drug prices. A significant provision requires healthcare providers enrolled in Medicare or participating in Medicaid to also participate in the Medicare Exchange health plan starting in 2028, with an opt-out process for exceptional circumstances. The bill also mandates the Secretary to explore and implement innovative payment mechanisms, such as value-based care and telehealth, to improve health outcomes, reduce disparities, and integrate medical care with social services like food and housing assistance. Beyond the public plan, the legislation makes substantial changes to the ACA's premium tax credits. It removes the income cap for eligibility , allowing more individuals to qualify for assistance, and revises the applicable percentages to reduce the share of income spent on premiums, including setting it at 0% for those up to 150% of the poverty line. Crucially, it addresses the " family glitch " by ensuring that employer-sponsored coverage is considered affordable for family members based on the cost of family coverage, not just self-only coverage. Finally, the bill seeks to improve market competition and affordability by repealing the prohibition on the Secretary negotiating prescription drug prices under Medicare Part D. It also authorizes significant appropriations for the Department of Justice's Antitrust Division and the Federal Trade Commission to strengthen antitrust enforcement and study anticompetitive practices in healthcare markets, alongside establishing a nationwide reinsurance mechanism to pool high-cost patient expenses in the individual market, aiming to further reduce premiums.