H.R. 6010 — To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.

This section establishes temporary initial and final premium percentages for the Affordable Care Act premium tax credit for taxable years 2026 and 2027 (i.e., preventing reversion to the higher statutory percentages applicable after 2025), as follows: (1) up to 150% of the federal poverty line (FPL), 0.0%–0.0%; (2) 150%–200% FPL, 0.0%–2.0%; (3) 200%–250% FPL, 2.0%–4.0%; (4) 250%–300% FPL, 4.0%–6.0%; (5) 300%–400% FPL, 6.0%–8.5%; (6) 400%–600% FPL, 8.5%–8.5%. It also temporarily increases the income threshold for premium tax credit eligibility to 600% FPL (from 400%). (The premium tax credit subsidizes Marketplace health insurance premiums by limiting required household contributions to these percentages of income, with the premium cap sliding from initial to final percentage within each tier.)

This section revises the risk adjustment methodology for Medicare Advantage (MA) payments for plan year 2026 and subsequent years as follows: (1) requires use of two years of diagnostic data (when available), rather than the prior one year; (2) excludes diagnoses collected from chart reviews or health risk assessments (i.e., data sources used by MA plans to identify conditions), with procedures for their identification and verification; and (3) requires annual evaluation of coding pattern differences between MA plans and traditional Medicare (Parts A and B), public reporting of results, and ensures the coding intensity adjustment fully accounts for such differences (potentially on a plan- or contract-specific basis). (As background, MA risk adjustment uses enrollee diagnoses to increase payments for higher-risk beneficiaries and includes a coding adjustment to address MA plans' tendency to submit more complete diagnoses than traditional Medicare.)

This section imposes new civil and criminal penalties on agents and brokers for negligent, knowing, or willful provision of incorrect or fraudulent information in Affordable Care Act (ACA) Exchange enrollment applications (i.e., under 42 U.S.C. 18081(b) or 18031(c)(8), or as specified by the Secretary). Specifically, it establishes (1) civil penalties of $10,000-$50,000 per affected individual for negligence or disregard of rules; (2) civil penalties up to $200,000 per individual for knowing violations, with assessment procedures mirroring those under Social Security Act §1128A (42 U.S.C. 1320a-7a, excluding subsections (a)-(b)); and (3) criminal penalties of a fine under 18 U.S.C., imprisonment up to 10 years, or both for knowing and willful violations. This section further requires the Secretary, for plan years beginning no later than January 1, 2028, to establish in federally-facilitated Exchanges (i.e., those operated by the Secretary under ACA §1321(c)(1)) a verification process for agent/broker-assisted new enrollments and coverage changes eligible for commissions. The process must include (1) documentation of enrollee consent (e.g., standardized form); (2) withholding commissions until eligibility inconsistencies are resolved; (3) issuer access to verification data; (4) timely notices to enrollees of changes with cancellation instructions; (5) enrollee access to account details (including agent of record and plan changes) via website, hotline, or platform; and (6) agent/broker reporting of third-party marketing organizations.