Rep. Mike Levin Reintroduces Legislation to Lower Health Care Premiums for Households Enrolled in both Medicare and Affordable Care Act Plans
Washington, D.C.—Today, Reps. Mike Levin (CA-49) and Linda Sanchez (CA-38) reintroduced the Health Insurance Premium Fairness Act, to help lower health care insurance premiums for households enrolled in both Medicare and Affordable Care Act (ACA) plans. This bill would close a loophole in the ACA that raises health premium costs for married couples when one spouse ages into Medicare and the other remains on an ACA marketplace plan.
The ACA premium tax credits cap premiums based on household income. However, when someone in the household ages into Medicare, the ACA tax credit formula does not factor in the premiums that person now pays into Medicare towards the household cap. As a result, ACA household premiums can increase by thousands of dollars per year.
The Health Insurance Premium Fairness Act would fix the glitch that forces seniors and their families to pay more in health premiums when one senior in the household ages into Medicare and others in the household remain on an ACA plan. The bill would ensure that Medicare premiums count towards the premium cap established by the ACA. For example, a couple whose household premiums are capped at $300 a month under the ACA will pay no more than $300 total if both spouses are on an ACA plan. However, when one spouse ages into Medicare and starts paying $200 in Medicare premiums, the couple will now be paying approximately $500 in total premiums. This bill will ensure that the $200 in Medicare premiums count towards the overall $300 cap, which would lower the second spouse’s ACA premiums to $100.
The bill aligns with the original intent of the ACA to maintain affordability for people with dual coverage and is a proposed solution to the ongoing fight in Congress around health care costs.
“American families should not be penalized when one person ages into Medicare and others in the household remain on an ACA plan. Our bill closes the loophole that forces seniors and their families to pay higher premiums and ensures that older couples can afford their health insurance,” said Rep. Levin. “In 2026, over 20 million Americans with ACA plans will face higher premiums. This bill is an important solution to cap premiums for thousands of households enrolled in both Medicare and ACA plans that may be unaware of the existing loophole. They should have the peace of mind that they will not have to pay more in premiums if a household member ages into Medicare. I thank Rep. Sanchez for her partnership on this bill, and we will continue fighting to ensure everyone is able to access the quality, affordable health care they deserve.”
“Republicans’ refusal to extend ACA credits has left millions of Americans paying more for their health coverage. We shouldn’t add to that burden by making older couples pay even higher prices just because one spouse moves to Medicare while the other remains on an ACA plan. Our bill ensures older couples can keep their coverage without needless financial stress,” said Rep. Sanchez
The ACA premium tax credits, which keep health premiums affordable for more than 20 million Americans, are set to expire at the end of 2025. If Congress does not extend the tax credits, health premiums will skyrocket in 2026. The glitch that causes premiums to increase when one household member ages into Medicare and the other remains on an ACA plan will continue to harm families regardless of whether the tax credits expire or are extended. The Health Insurance Premium Fairness Act would solve this issue.
“My wife and I were both enrolled in an Affordable Care Act marketplace insurance plan via Covered California, but when I went on Medicare in the Fall of 2021, a loophole in the ACA’s premium cost calculator caused our overall insurance costs, including all Medicare costs, to rise from approximately $300 per month to over $600 per month,” said Constituent Ted DeBont. “I knew we couldn’t be the only folks facing this dilemma. I’m grateful to Rep. Levin and his team for meeting with me to hear about our situation and for introducing a bill that would save us—and many folks like us—thousands of dollars per year.”
This bill is endorsed by: Protect Our Care, Alliance for Retired Americans, National Committee to Preserve Social Security & Medicare, Social Security Works, Justice in Aging, Center for Medicare Advocacy, and Third Way.
###