Care Over Profits Act of 2026 increases medical loss ratio and imposes penalties on agents and brokers for fraudulent enrollment.
The Care Over Profits Act of 2026 amends the Public Health Service Act to increase the medical loss ratio for health insurance coverage in small group and individual markets from 80% to 85%. It also amends the Patient Protection and Affordable Care Act to impose civil and criminal penalties on agents and brokers who knowingly and willfully provide false or fraudulent information during enrollment in qualified health plans offered through an Exchange. Effective dates for these changes are set for plan years beginning on or after January 1, 2026, and January 1, 2027, respectively.
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- Core Provisions
- Implementation
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- Legal Framework
- Critical Issues
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