SUBCHAPTER A—IMPROVING ELIGIBILITY CRITERIA
SEC. 71301. Permitting premium tax credit only for certain individuals.
(a) In general.—Section 36B(e)(1) is amended by inserting “or, in the case of aliens who are lawfully present, are not eligible aliens” after “individuals who are not lawfully present”.
(b) Eligible aliens.—Section 36B(e)(2) is amended—
(1) by striking “For purposes of this section, an individual” and inserting “For purposes of this section—
“(A) IN GENERAL.—An individual”, and
(2) by adding at the end the following new subparagraph:
“(B) ELIGIBLE ALIENS.—An individual who is an alien and lawfully present shall be treated as an eligible alien if such individual is, and is reasonably expected to be for the entire period of enrollment for which the credit under this section is being claimed—
“(i) an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act (8 U.S.C. 1101 et seq.),
“(ii) an alien who has been granted the status of Cuban and Haitian entrant, as defined in section 501(e) of the Refugee Education Assistance Act of 1980 (Public Law 96–422); or
“(iii) an individual who lawfully resides in the United States in accordance with a Compact of Free Association referred to in section 402(b)(2)(G) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)(G)).”.
(c) Conforming amendments.—
(1) VERIFICATION OF INFORMATION.—Section 1411 of the Patient Protection and Affordable Care Act (42 U.S.C. 18081) is amended—
(A) in subsection (a)—
(i) in paragraph (1), by striking “and section 36B(e) of the Internal Revenue Code of 1986”; and
(ii) in paragraph (2)—
(I) in subparagraph (A), by striking “and” at the end;
(II) in subparagraph (B), by adding “and” at the end; and
(III) by adding at the end the following new subparagraph:
“(C) in the case such individual is an alien lawfully present in the United States, whether such individual is an eligible alien (within the meaning of section 36B(e)(2) of such Code);”;
(B) in subsection (b)(3), by adding at the end the following new subparagraph:
“(D) IMMIGRATION STATUS.—In the case the individual’s eligibility is based on an attestation of the enrollee’s immigration status, an attestation that such individual is an eligible alien (within the meaning of 36B(e)(2) of the Internal Revenue Code of 1986).”; and
(C) in subsection (c)(2)(B)(ii), by adding at the end the following new subclause:
“(III) In the case of an individual described in clause (i)(I) with respect to whom a premium tax credit under section 36B of the Internal Revenue Code of 1986 is being claimed, the attestation that the individual is an eligible alien (within the meaning of section 36B(e)(2) of such Code).”.
(2) ADVANCE DETERMINATIONS.—Section 1412(d) of the Patient Protection and Affordable Care Act (42 U.S.C. 18082(d)) is amended by inserting before the period at the end the following: “, or credits under section 36B of the Internal Revenue Code of 1986 for aliens who are not eligible aliens (within the meaning of section 36B(e)(2) of such Code)”.
(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2027.
(d) Requirement to maintain minimum essential coverage.—Section 5000A(d)(3) is amended by striking “an alien lawfully present in the United States” and inserting “an eligible alien (within the meaning of section 36B(e)(2))”.
(e) Effective date.—The amendments made by this section (other than the amendments made by subsection (c)) shall apply to taxable years beginning after December 31, 2026.
SEC. 71302. Disallowing premium tax credit during periods of medicaid ineligibility due to alien status.
(a) In general.—Section 36B(c)(1) is amended by striking subparagraph (B).
(b) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2025.
SUBCHAPTER B—PREVENTING WASTE, FRAUD, AND ABUSE
SEC. 71303. Requiring verification of eligibility for premium tax credit.
(a) In general.—Section 36B(c) is amended by adding at the end the following new paragraphs:
“(5) EXCHANGE ENROLLMENT VERIFICATION REQUIREMENT.—
“(A) IN GENERAL.—The term ‘coverage month’ shall not include, with respect to any individual covered by a qualified health plan enrolled in through an Exchange, any month beginning before the Exchange verifies, using applicable enrollment information that shall be provided or verified by the applicant, such individual’s eligibility—
“(i) to enroll in the plan through the Exchange, and
“(ii) for any advance payment under section 1412 of the Patient Protection and Affordable Care Act of the credit allowed under this section.
“(B) APPLICABLE ENROLLMENT INFORMATION.—For purposes of subparagraph (A), applicable enrollment information shall include affirmation of at least the following information (to the extent relevant in determining eligibility described in subparagraph (A)):
“(i) Household income and family size.
“(ii) Whether the individual is an eligible alien.
“(iii) Any health coverage status or eligibility for coverage.
“(iv) Place of residence.
“(v) Such other information as may be determined by the Secretary (in consultation with the Secretary of Health and Human Services) as necessary to the verification prescribed under subparagraph (A).
“(C) VERIFICATION OF PAST MONTHS.—In the case of a month that begins before verification prescribed by subparagraph (A), such month shall be treated as a coverage month if the Exchange verifies for such month (using applicable enrollment information that shall be provided or verified by the applicant) such individual’s eligibility to have so enrolled and for any such advance payment.
“(D) EXCHANGE PARTICIPATION; COORDINATION WITH OTHER PROCEDURES FOR DETERMINING ELIGIBILITY.—An individual shall not, solely by reason of failing to meet the requirements of this paragraph with respect to a month, be treated for such month as ineligible to enroll in a qualified health plan through an Exchange.
“(E) WAIVER FOR CERTAIN SPECIAL ENROLLMENT PERIODS.—The Secretary may waive the application of subparagraph (A) in the case of an individual who enrolls in a qualified health plan through an Exchange for 1 or more months of the taxable year during a special enrollment period provided by the Exchange on the basis of a change in the family size of the individual.
“(F) INFORMATION AND RELIANCE ON THIRD-PARTY SOURCES.—An Exchange shall be permitted to use any data available to the Exchange and any reliable third-party sources in collecting information for verification by the applicant.
“(6) EXCHANGE COMPLIANCE WITH FILING REQUIREMENTS.—The term ‘coverage month’ shall not include, with respect to any individual covered by a qualified health plan enrolled in through an Exchange, any month for which the Exchange does not meet the requirements of section 155.305(f)(4)(iii) of title 45, Code of Federal Regulations (as published in the Federal Register on June 25, 2025 (90 Fed. Reg. 27074), applied as though it applied to all plan years after 2025), with respect to the individual.”.
(b) Pre-enrollment verification process required.—Section 36B(c)(3)(A) is amended—
(1) by striking “health plan.—The term” and inserting “health plan.—
“(i) IN GENERAL.—The term”, and
(2) by adding at the end the following new clause:
“(ii) PRE-ENROLLMENT VERIFICATION PROCESS REQUIRED.—Such term shall not include any plan enrolled in through an Exchange, unless such Exchange provides a process for pre-enrollment verification through which any applicant may, beginning not later than August 1, verify with the Exchange the applicant’s household income and eligibility for enrollment in such plan for plan years beginning in the subsequent year.”.
(c) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2027.
SEC. 71304. Disallowing premium tax credit in case of certain coverage enrolled in during special enrollment period.
(a) In general.—Section 36B(c)(3)(A), as amended by the preceding provisions of this Act, is amended by adding at the end the following new clause:
“(iii) EXCEPTION IN CASE OF CERTAIN SPECIAL ENROLLMENT PERIODS.—Such term shall not include any plan enrolled in during a special enrollment period provided for by an Exchange—
“(I) on the basis of the relationship of the individual’s expected household income to such a percentage of the poverty line (or such other amount) as is prescribed by the Secretary of Health and Human Services for purposes of such period, and
“(II) not in connection with the occurrence of an event or change in circumstances specified by the Secretary of Health and Human Services for such purposes.”.
(b) Effective date.—The amendments made by this section shall apply with respect to plan years beginning after December 31, 2025.
SEC. 71305. Eliminating limitation on recapture of advance payment of premium tax credit.
(a) In general.—Section 36B(f)(2) is amended by striking subparagraph (B).
(b) Conforming amendments.—
(1) Section 36B(f)(2) is amended by striking “advance payments.—” and all that follows through “If the advance payments” and inserting the following: “advance payments.—If the advance payments”.
(2) Section 35(g)(12)(B)(ii) is amended by striking “then section 36B(f)(2)(B) shall be applied by substituting the amount determined under clause (i) for the amount determined under section 36B(f)(2)(A)” and inserting “then the amount determined under clause (i) shall be substituted for the amount determined under section 36B(f)(2)”.
(c) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2025.
SUBCHAPTER C—ENHANCING CHOICE FOR PATIENTS
SEC. 71306. Permanent extension of safe harbor for absence of deductible for telehealth services.
(a) In general.—Subparagraph (E) of section 223(c)(2) is amended to read as follows:
“(E) SAFE HARBOR FOR ABSENCE OF DEDUCTIBLE FOR TELEHEALTH.—A plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for telehealth and other remote care services.”.
(b) Certain coverage disregarded.—Clause (ii) of section 223(c)(1)(B) is amended by striking “(in the case of months or plan years to which paragraph (2)(E) applies)”.
(c) Effective date.—The amendments made by this section shall apply to plan years beginning after December 31, 2024.
SEC. 71307. Allowance of bronze and catastrophic plans in connection with health savings accounts.
(a) In general.—Section 223(c)(2) is amended by adding at the end the following new subparagraph:
“(H) BRONZE AND CATASTROPHIC PLANS TREATED AS HIGH DEDUCTIBLE HEALTH PLANS.—The term ‘high deductible health plan’ shall include any plan which is—
“(i) available as individual coverage through an Exchange established under section 1311 or 1321 of the Patient Protection and Affordable Care Act, and
“(ii) described in subsection (d)(1)(A) or (e) of section 1302 of such Act.”.
(b) Effective date.—The amendment made by this section shall apply to months beginning after December 31, 2025.
SEC. 71308. Treatment of direct primary care service arrangements.
(a) In general.—Section 223(c)(1) is amended by adding at the end the following new subparagraph:
“(E) TREATMENT OF DIRECT PRIMARY CARE SERVICE ARRANGEMENTS.—
“(i) IN GENERAL.—A direct primary care service arrangement shall not be treated as a health plan for purposes of subparagraph (A)(ii).
“(ii) DIRECT PRIMARY CARE SERVICE ARRANGEMENT.—For purposes of this subparagraph—
“(I) IN GENERAL.—The term ‘direct primary care service arrangement’ means, with respect to any individual, an arrangement under which such individual is provided medical care (as defined in section 213(d)) consisting solely of primary care services provided by primary care practitioners (as defined in section 1833(x)(2)(A) of the Social Security Act, determined without regard to clause (ii) thereof), if the sole compensation for such care is a fixed periodic fee.
“(II) LIMITATION.—With respect to any individual for any month, such term shall not include any arrangement if the aggregate fees for all direct primary care service arrangements (determined without regard to this subclause) with respect to such individual for such month exceed $150 (twice such dollar amount in the case of an individual with any direct primary care service arrangement (as so determined) that covers more than one individual).
“(iii) CERTAIN SERVICES SPECIFICALLY EXCLUDED FROM TREATMENT AS PRIMARY CARE SERVICES.—For purposes of this subparagraph, the term ‘primary care services’ shall not include—
“(I) procedures that require the use of general anesthesia,
“(II) prescription drugs (other than vaccines), and
“(III) laboratory services not typically administered in an ambulatory primary care setting.
The Secretary, after consultation with the Secretary of Health and Human Services, shall issue regulations or other guidance regarding the application of this clause.”.
(b) Direct primary care service arrangement fees treated as medical expenses.—Section 223(d)(2)(C) is amended by striking “or” at the end of clause (iii), by striking the period at the end of clause (iv) and inserting “, or”, and by adding at the end the following new clause:
“(v) any direct primary care service arrangement.”.
(c) Inflation adjustment.—Section 223(g)(1) is amended—
(1) by striking “in subsections (b)(2) and (c)(2)(A)” and inserting “in subsections (b)(2), (c)(2)(A), and in the case of taxable years beginning after 2026, (c)(1)(E)(ii)(II)”,
(2) in subparagraph (B), by striking “clause (ii)” in clause (i) and inserting “clauses (ii) and (iii)”, by striking “and” at the end of clause (i), by striking the period at the end of clause (ii) and inserting “, and”, and by inserting after clause (ii) the following new clause:
“(iii) in the case of the dollar amount in subsection (c)(1)(E)(ii)(II), ‘calendar year 2025’.”, and
(3) by inserting “, (c)(1)(E)(ii)(II),” after “(b)(2)” in the last sentence.
(d) Effective date.—The amendments made by this section shall apply to months beginning after December 31, 2025.