The Care Over Profits Act of 2026 makes two main changes to health insurance regulations. First, it increases the medical loss ratio requirement for individual and small group health insurance plans from 80% to 85%, meaning insurance companies must spend a larger share of premium dollars on actual medical care rather than administrative costs and profits, effective January 1, 2026. Second, the bill cracks down on fraudulent enrollment in health insurance by imposing significant penalties on insurance agents and brokers who provide incorrect or false information during enrollment, including civil penalties ranging from $10,000 to $50,000 for negligent violations and up to $200,000 for knowing and willful violations, plus criminal penalties of up to 10 years in prison for intentional fraud, effective January 1, 2027. The legislation targets dishonest enrollment practices while requiring insurers to allocate more revenue toward patient care, affecting individuals seeking health coverage through exchanges and the insurance industry broadly.
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