S 4583 — Legalizing Premium Health Care Act of 2026

Summary

Legalizing Premium Health Care Act of 2026This bill allows any Medicare beneficiary to enter into a contract with an eligible professional, regardless of whether the professional is participating in Medicare, for any item or service covered by Medicare.Such beneficiaries may submit a claim for Medicare payment in the amount that would otherwise apply, except that, where the professional is considered to be non-participating, payment shall be made as if the professional were participating. An eligible professional is a physician, physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, registered dietitian or nutrition professional, physical or occupational therapist, qualified speech-language pathologist, or qualified audiologist.A Medicare beneficiary must agree in writing in such a contract to (1) pay the eligible professional for a Medicare-covered item or service; and (2) submit, in lieu of the eligible professional, a claim for Medicare payment. However, a beneficiary may negotiate, as a term of the contract, for the eligible professional to file such claims on the beneficiary's behalf.The bill preempts state laws from limiting the amount of charges for physician and practitioner services for which Medicare payment is made.

Bill Text

• Introduced Introduced in Senate Current html May 20, 2026

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill establishes new provisions for Medicare beneficiaries to freely contract with eligible professionals while ensuring they can still use their Medicare benefits.

• 42 U.S.C. 1395a

  use of private contracts by medicare beneficiaries → freedom To Contract by Medicare Beneficiaries.--

  This change updates the section title to emphasize the freedom of Medicare beneficiaries to contract.

• 42 U.S.C. 1395a

  nothing in this subchapter shall prohibit a physician or practitioner from entering into a private contract with a medicare beneficiary for any item or service— → nothing in this title shall prohibit a Medicare beneficiary from entering into a contract with an eligible professional (whether or not the professional is a participating or non-participating physician or practitioner) for any item or service covered under this title.

  This change broadens the eligibility for professionals that Medicare beneficiaries can contract with.

• 42 U.S.C. 1395a

  any contract to provide items and services to which paragraph (1) applies shall clearly indicate to the medicare beneficiary that by signing such contract the beneficiary— → Any contract to provide items and services to which paragraph (1) applies shall clearly indicate to the Medicare beneficiary that by signing such contract the beneficiary—

  This change standardizes terminology, ensuring 'Medicare' is always capitalized in this context.

• 42 U.S.C. 1395a

  acknowledges that the medicare beneficiary has the right to have such items or services provided by other physicians or practitioners for whom payment would be made under this subchapter. → acknowledges that the Medicare beneficiary has the right to have such items or services provided by other physicians or practitioners for whom payment would be made under this title.

  This change clarifies that beneficiaries have rights to receive services under the specified title of the act.

• 42 U.S.C. 1395f(a)(7)(D)(i)(II)

  and is not an opt-out physician or practitioner (as defined in section 1802(b)(6)(D))

  This change removes the requirement for a physician to not be an opt-out practitioner in certain qualifications.

• 42 U.S.C. 1395a

  Section 1848(g) shall not apply with respect to any item or service provided to a Medicare beneficiary under a contract described in paragraph (1).

  This addition exempts certain contracts from payment limitations established in section 1848(g).

• 42 U.S.C. 1395a

  No State may impose a limit on the amount of charges for services, furnished by an eligible professional, for which payment is made under such section, and any such limit is hereby preempted.

  This provision ensures no state restrictions on how much can be charged for services covered under this contract.

Action History

1. May 20, 2026

   Introduced in Senate

2. May 20, 2026

   Read twice and referred to the Committee on Finance.

Sponsors

• Lisa Murkowski · Cosponsor
• Rand Paul · Primary

Subjects