Preserving Patient Access Act
- Sponsor
- Sen. Rosen, Jacky [D-NV]
- Committees
- Health, Education, Labor, and Pensions Committee (primary)
- Last action
- Jun 24, 2026
Bottom line
The bill aims to protect patients from unexpected mid-year disruptions to their healthcare provider networks and prescription drug coverage by allowing them to switch health plans.
What it actually does
This bill establishes new special enrollment periods for individuals enrolled in Medicare Advantage plans, Medicare Part D plans, and individual market health insurance plans. These special enrollment periods are triggered if a patient's in-network healthcare provider (whom they have seen within the last two years) becomes out-of-network, or if their plan implements a 'negative formulary change' for a prescription drug they have been dispensed within the previous six months.
Proponents argue
Supporters argue that this bill empowers patients by providing crucial flexibility and protection against disruptive mid-year changes in their health coverage, ensuring continuity of care and access to necessary medications. It prevents situations where patients are suddenly forced to pay out-of-network costs or switch essential drugs due to unforeseen plan modifications.
Opponents contend
Opponents might contend that expanding special enrollment periods could introduce instability into the insurance markets, potentially increasing administrative burdens for insurers and leading to higher premiums if individuals frequently switch plans. They may also argue that existing protections are sufficient or that such changes should be limited to annual enrollment periods to maintain market predictability.
The bill is very short and easy to read, allowing ample time for a thorough evaluation of its provisions.
Section 2(a)(1)
Special Enrollment for Medicare Advantage Provider Changes
This provision amends the Social Security Act to allow Medicare Advantage enrollees a special opportunity to switch plans. This special enrollment period is triggered if a healthcare provider with whom the individual has had an in-person or telehealth visit within the preceding two-year period, and who was listed as an in-network provider, becomes an out-of-network provider under the plan. This ensures beneficiaries are not suddenly left without in-network access to their established doctors.
Supporters argue
Supporters argue this provision protects vulnerable seniors from losing access to their trusted doctors mid-year, which can be highly disruptive to their health management and financial planning. It enhances patient choice and plan accountability.
Critics contend
Critics might argue that frequent mid-year enrollment changes could complicate risk pool management for MA plans, potentially leading to higher premiums or reduced plan stability for all beneficiaries.
Tradeoffs
Balances patient flexibility and continuity of care against potential administrative complexities and market stability concerns for Medicare Advantage plans.
Section 2(a)(2)
Special Enrollment for Medicare Part D Negative Formulary Changes
This provision creates a special enrollment period for individuals enrolled in Medicare Part D or MA-PD plans. This period is triggered if their plan implements a 'negative formulary change' for a prescription drug they have been dispensed within the previous six months, provided the drug's approval or licensure is still in effect. A 'negative formulary change' generally means the drug's coverage terms worsen (e.g., moved to a higher cost tier, removed from formulary).
Section 2(b)(1)
Special Enrollment for Individual Market Provider and Formulary Changes
This provision mandates that health insurance issuers offering individual market coverage establish special enrollment periods. These periods are available if an individual's in-network provider (whom they have seen within the last two years) becomes out-of-network, or if the plan implements a 'negative formulary change' for a prescription drug the individual has recently used (within the previous six months). This extends similar protections to those in Medicare to the individual health insurance market.
The bill defines 'negative formulary change' by referencing 'section 423.100 of title 42, Code of Federal Regulations (or successor regulations).' For individual market plans, it specifies a substitution for 'a covered Part D drug'.
Section 2(a)(2)(ii) and Section 2(b)(1)(B)(ii)
Why it matters:This is standard legislative practice to avoid reprinting lengthy regulatory definitions and to ensure consistency with existing administrative law.
Case for: Referencing existing regulations provides clarity and consistency, leveraging established legal frameworks without introducing new, potentially conflicting definitions.
Case against: A reader must consult external documents to fully understand a key term, which can hinder immediate comprehension of the bill's full impact.
Estimated impact: This definition is central to the bill's effect on prescription drug coverage, determining when a special enrollment period is triggered.