US HB7164

Upgrades cost-sharing reduction benchmark from silver-level to gold-level plans for Exchange enrollees beginning January 1, 2028

Increases plan cost-sharing coverage to 87% for eligible individuals with household incomes between 150-300% of the federal poverty line (up from the current 150-200% threshold)

Raises plan cost-sharing coverage to 85% for individuals with incomes between 300-400% of the federal poverty line, effective for plan years starting January 1, 2028

Changes premium tax credit calculations under Internal Revenue Code Section 36B to use the second lowest cost gold plan instead of silver plan, effective for taxable years after December 31, 2027

Appropriates necessary funding from the Treasury for cost-sharing reduction payments and updates State Basic Health Program calculations to align with the new gold-level benchmark