Section 1 Short title
This Act may be cited as the “Protecting Access to Affordable Coverage Act of 2025”.
Protecting Access to Affordable Coverage Act of 2025
A BILL
To amend the Patient Protection and Affordable Care Act to facilitate the enrollment of individuals in qualified health plans.
Sec. 2 Facilitating the enrollment of individuals in qualified health plans
Extending the open enrollment period for plan year 2026— Section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) is amended-—
in subparagraph (B), by inserting “, subject to subparagraph (E),” after “as determined by the Secretary”;
in subparagraph (C), by striking “and” at the end;
in subparagraph (D), by striking the period and inserting “; and”; and
by adding at the end the following new subparagraph:
“(E) an open enrollment period for enrollments for plan year 2026 that begins not later than November 1, 2025, and ends not earlier than May 1, 2026.”
Repeal of certain verification requirements— The amendments made by section 71303 of an Act to provide for reconciliation pursuant to title II of H. Con. Res. 14 (Public Law 119–21) are repealed, and any provision of law amended by such section is restored or revived as if such amendments had never been enacted.
Ensuring enrollment opportunities for certain individuals—
In general— Section 36B(c)(3)(A) of the Internal Revenue Code of 1986 is amended by striking clause (iii).
Establishment of special enrollment period—
In general— Section 1311(c)(6) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)), as amended by subsection (a), is further amended—
in subparagraph (D), by striking “and” at the end;
in subparagraph (E), by striking the period and inserting “; and”; and
by adding at the end the following new subparagraph:
“(F) a special enrollment period once per month for an individual who is eligible for the advance payment of premium tax credits under section 1412 and whose household income is not expected to exceed 150 percent of the poverty line for a family of the size involved.”
Effective date— The amendments made by subparagraph (A) shall apply with respect to plan years beginning on or after January 1, 2026.
Navigator grants— Section 1311(i) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(i)) is amended—
in paragraph (2), by adding at the end the following new subparagraph:
“(C) Mandatory grant—In awarding grants under paragraph (1), the Exchange shall, for each plan year (beginning with plan year 2026)—
“(i) award such grants only to entities with a physical presence in the State of such Exchange; and
“(ii) award such a grant to at least 1 entity described in this paragraph.”
in paragraph (4)(A)—
in the matter preceding clause (i), by inserting “(financial or otherwise)” after “interest”;
in clause (i), by striking “or” at the end;
in clause (ii), by striking the period and inserting “; or”; and
by adding at the end the following new clause:
“(iii) for plan year 2026 or a subsequent plan year—
“(I) be an enhanced direct enrollment entity;
“(II) charge any fees to applicants or enrollees; or
“(III) request any form of remuneration from or on behalf of any applicant or enrollee.”
in paragraph (6)—
by striking “Funding.—Grants under” and inserting
“(A) State Exchanges—Grants under”
by adding at the end the following new subparagraph:
“(B) Federal Exchanges
“(i) In general—For purposes of carrying out this subsection, with respect to Exchanges established and operated by the Secretary pursuant to section 1321(c), the Secretary shall obligate $100,000,000 out of amounts collected through the user fees on participating health insurance issuers pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations) for fiscal year 2026 and each subsequent fiscal year. Such amount for a fiscal year shall remain available until expended.
“(ii) Allocation
“(I) In general—The Secretary shall, out of amounts obligated under clause (i) for a fiscal year, allocate to each Exchange established and operated by the Secretary in a State pursuant to section 1321(c), for making grants under paragraph (1) during such fiscal year—
“(aa) $1,250,000; plus
“(bb) an amount that bears the same ratio to the total remaining obligated funds (as defined in subclause (II)) for such fiscal year as the number of individuals enrolled in a qualified health plan offered through an Exchange established in such State, or enrolled under the State plan of such State under title XIX (or waiver of such plan), during the preceding fiscal year bears to the total number of individuals enrolled in such a plan offered through an Exchange established in any State that is a specified State (as defined in subclause (II)) with respect to such fiscal year, or enrolled under the State plan of any such State under title XIX (or waiver of such plan), during such preceding fiscal year.
“(II) Definitions—In this clause:
“(aa) Total remaining obligated funds—The term “total remaining obligated funds” means, with respect to a fiscal year, $100,000,000, less an amount equal to the product of—
“(AA) $1,250,000; and
“(BB) the number of Exchanges described in clause (i) for such fiscal year.
“(bb) Specified State—The term “specified State” means, with respect to a fiscal year, a State in which the Secretary establishes and operates an Exchange pursuant to section 1321(c).”