Legalizing Premium Health Care Act of 2026

This bill would allow Medicare beneficiaries to enter into private contracts with healthcare professionals for covered services, regardless of whether the provider participates in the Medicare program. Under these agreements, beneficiaries would be responsible for paying the provider directly and would then submit claims to Medicare for reimbursement at the standard participating provider rate. Additionally, the bill proposes to preempt state laws that limit the amount physicians and practitioners can charge for services covered by Medicare.

This bill affects Medicare beneficiaries by allowing them to enter into private contracts for covered items and services with healthcare professionals regardless of the provider's Medicare participation status. It also impacts a wide range of eligible professionals, including physicians, nurse practitioners, clinical social workers, and various therapists, who would be permitted to receive direct payment from beneficiaries under these contracts. Additionally, the legislation affects state governments by preempting state laws that limit charges for physician and practitioner services for which Medicare payment is made.

• Direct Contracting for Medicare Services. Allows Medicare beneficiaries to enter into private contracts with eligible healthcare professionals for Medicare-covered items or services, regardless of whether the professional participates in the Medicare program.
• Medicare Reimbursement for Private Contracts. Permits beneficiaries to submit claims for Medicare payment at the standard participating professional rate, even if the service provider is considered non-participating.
• Beneficiary and Professional Responsibilities. Requires beneficiaries to agree in writing to pay the professional and handle claim submissions, though they may negotiate for the professional to file claims on their behalf.
• Preemption of State Charge Limits. Prohibits state laws from limiting the amount healthcare practitioners can charge for services for which Medicare payment is made.

The bill modifies Medicare payment and contracting rules by allowing beneficiaries to contract privately with healthcare professionals for covered services, regardless of the professional's participation status in the program. It also preempts state laws that limit charges for physician and practitioner services for which Medicare payment is made.

The bill seeks to expand the ability of Medicare beneficiaries to contract directly with healthcare professionals of their choice for covered services, regardless of the provider's Medicare participation status. It aims to facilitate these private arrangements by allowing beneficiaries to seek Medicare reimbursement for such services and by preempting state-level limits on practitioner charges.