S. 4583

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4583 Introduced in Senate (IS)]

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119th CONGRESS
2d Session
S. 4583

To amend title XVIII of the Social Security Act to establish a Medicare 
payment option for patients and eligible professionals to freely 
contract, without penalty, for Medicare fee-for-service items and 
services, while allowing Medicare beneficiaries to use their Medicare 
benefits.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

May 20, 2026

Mr. Paul (for himself and Ms. Murkowski) introduced the following bill; 
which was read twice and referred to the Committee on Finance

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to establish a Medicare 
payment option for patients and eligible professionals to freely 
contract, without penalty, for Medicare fee-for-service items and 
services, while allowing Medicare beneficiaries to use their Medicare 
benefits.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Legalizing Premium Health Care Act 
of 2026''.

SEC. 2. GUARANTEEING FREEDOM OF CHOICE AND CONTRACTING FOR PATIENTS 
UNDER MEDICARE.

(a) In General.--Section 1802 of the Social Security Act (42 U.S.C. 
1395a) is amended to read as follows:

``freedom of choice and contracting by patient guaranteed

``Sec. 1802. (a) Basic Freedom of Choice.--Any individual entitled 
to insurance benefits under this title may obtain health services from 
any institution, agency, or person qualified to participate under this 
title if such institution, agency, or person undertakes to provide that 
individual such services.
``(b) Freedom To Contract by Medicare Beneficiaries.--
``(1) In general.--Subject to the provisions of this 
subsection, 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.
``(2) Submission of claims.--Any Medicare beneficiary that 
enters into a contract under this section with an eligible 
professional shall be permitted to submit a claim for payment 
under this title for services furnished by such professional, 
and such payment shall be made in the amount that would 
otherwise apply to such professional under this title except 
that where such professional is considered to be non-
participating, payment shall be paid as if the professional 
were participating. Payment made under this title for any item 
or service provided under the contract shall not render the 
professional a participating or non-participating physician or 
practitioner, and as such, requirements of this title that may 
otherwise apply to a participating or non-participating 
physician or practitioner would not apply with respect to any 
items or services furnished under the contract.
``(3) Beneficiary protections.--
``(A) In general.--Paragraph (1) shall not apply to 
any contract unless--
``(i) the contract is in writing, is signed 
by the Medicare beneficiary and the eligible 
professional, and establishes all terms of the 
contract (including specific payment for items 
and services covered by the contract) before 
any item or service is provided pursuant to the 
contract, and the beneficiary shall be held 
harmless for any subsequent payment charged for 
an item or service in excess of the amount 
established under the contract during the 
period the contract is in effect;
``(ii) the contract contains the items 
described in subparagraph (B); and
``(iii) the contract is not entered into at 
a time when the Medicare beneficiary is facing 
an emergency medical condition or urgent health 
care situation.
``(B) Items required to be included in contract.--
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--
``(i) agrees to be responsible for payment 
to such eligible professional for such items or 
services under the terms of and amounts 
established under the contract;
``(ii) agrees to be responsible for 
submitting claims under this title to the 
Secretary, and to any other supplemental 
insurance plan that may provide supplemental 
insurance, for such items or services furnished 
under the contract if such items or services 
are covered by this title, unless otherwise 
provided in the contract under subparagraph 
(C)(i); and
``(iii) acknowledges that no limits or 
other payment incentives that may otherwise 
apply under this title (such as the limits 
under subsection (g) of section 1848 or 
incentives under subsection (a)(5), (m), (p), 
and (q) of such section) shall apply to amounts 
that may be charged, or paid to a beneficiary 
for, such items or services.
Such contract shall also clearly indicate whether the 
eligible professional is excluded from participation 
under the Medicare program under section 1128.
``(C) Beneficiary elections under the contract.--
Any Medicare beneficiary that enters into a contract 
under this section may elect to negotiate, as a term of 
the contract, a provision under which--
``(i) the eligible professional shall file 
claims on behalf of the beneficiary with the 
Secretary and any supplemental insurance plan 
for items or services furnished under the 
contract if such items or services are covered 
under this title or under the plan; and
``(ii) the beneficiary assigns payment to 
the eligible professional for any claims filed 
by, or on behalf of, the beneficiary with the 
Secretary and any supplemental insurance plan 
for items or services furnished under the 
contract.
``(D) Exclusion of dual eligible individuals.--
Paragraph (1) shall not apply to any contract if a 
beneficiary who is eligible for medical assistance 
under title XIX is a party to the contract.
``(4) Limitation on actual charge and claim submission 
requirement not applicable.--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).
``(5) Construction.--Nothing in this section shall be 
construed--
``(A) to prohibit any eligible professional from 
maintaining an election and acting as a participating 
or non-participating physician or practitioner with 
respect to any patient not covered under a contract 
established under this section; and
``(B) as changing the items and services for which 
an eligible professional may bill under this title.
``(6) Definitions.--In this subsection:
``(A) Medicare beneficiary.--The term `Medicare 
beneficiary' means an individual who is entitled to 
benefits under part A or enrolled under part B.
``(B) Eligible professional.--The term `eligible 
professional' has the meaning given such term in 
section 1848(k)(3)(B).
``(C) Emergency medical condition.--The term 
`emergency medical condition' means a medical condition 
manifesting itself by acute symptoms of sufficient 
severity (including severe pain) such that a prudent 
layperson, with an average knowledge of health and 
medicine, could reasonably expect the absence of 
immediate medical attention to result in--
``(i) serious jeopardy to the health of the 
individual or, in the case of a pregnant woman, 
the health of the woman or her unborn child;
``(ii) serious impairment to bodily 
functions; or
``(iii) serious dysfunction of any bodily 
organ or part.
``(D) Participating; non-participating.--The terms 
`participating' and `nonparticipating' have the 
meanings given such terms under subsection (h) of 
section 1842 for purposes of such section.
``(E) Urgent health care situation.--The term 
`urgent health care situation' means services furnished 
to an individual who requires services to be furnished 
within 12 hours in order to avoid the likely onset of 
an emergency medical condition.''.
(b) Conforming Amendment.--Section 1814(a)(7)(D)(i)(II) of the 
Social Security Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)) is amended by 
striking ``and is not an opt-out physician or practitioner (as defined 
in section 1802(b)(6)(D))''.

SEC. 3. PREEMPTION OF STATE LAWS LIMITING CHARGES FOR SERVICES BY AN 
ELIGIBLE PROFESSIONAL.

(a) In General.--No State may impose a limit on the amount of 
charges for services, furnished by an eligible professional (as defined 
in subsection (k)(3)(B) of section 1848 of the Social Security Act, 42 
U.S.C. 1395w-4), for which payment is made under such section, and any 
such limit is hereby preempted.
(b) State.--In this section, the term ``State'' includes the 
District of Columbia, Puerto Rico, the Virgin Islands, Guam, and 
American Samoa.
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