Idaho Legislature – VOTE YES on H0529 - Health care cash payments (Posted: 01/27/26)

• Link: legislature.idaho.gov/s…

• See bill link above for current status and committee assignment

• See Idaho Insider for links where you can send group emails based on current status and committee assignment: gemstatechronicle.com/l…

Summary (ai assisted)

H0529 allows covered persons under health benefit plans to pay out-of-pocket discounted cash prices for medically necessary health care services, prohibits health carriers from restricting providers from offering such options, and requires carriers to credit negotiated lower out-of-pocket payments toward deductibles and maximums if documentation is provided. Provides exemptions for certain plans. No contradictions with US Constitution or Idaho Constitution.

Key Provisions

• Defines "covered person," "health benefit plan," "health care provider," "health care services," "health carrier," and "medically necessary."

• "Discounted cash price" means the charge for cash payment without claiming insurance; for hospitals, aligns with 45 CFR 180.20 if applicable, excluding free care or financial assistance amounts.

Prohibitions and Rights

• Health carriers cannot prohibit providers from offering discounted cash prices to covered persons.

• Covered persons may opt to pay out-of-pocket instead of submitting claims.

• For medically necessary covered services, if a lower price than the plan's average allowed amount is negotiated and paid out-of-pocket, it counts toward deductible and annual maximum out-of-pocket.

Carrier Duties

• Carriers must credit full out-of-pocket amount if service is covered and price is lower than average allowed, upon receiving documentation.

• Documentation includes: service details, provider info, order if required, final bill, negotiated cost, proof of payment, and confirmation of no claim to carrier.

• Providers must accept cash payment as full and not bill for balances.

• Credits apply to in-network or out-of-network deductibles/maximums based on provider status.

• Amounts do not exceed required out-of-pocket for plan period or carry over.

Exemptions

• Specified disease, accidental death/dismemberment, dental/vision only plans.

• Individual limited benefit, hospital indemnity, disability income, accident-only/disability combo, or liability supplement policies.

• Idaho Medicaid programs under Title XIX.

• Medicare supplemental policies per Social Security Act Section 1882(g)(1).

• Worker's compensation.

• Medical payment in motor vehicle insurance.

• Long-term care or nursing home fixed indemnity (unless deemed comprehensive health plan).

• Short-term nonrenewable health insurance (6 months or less).

Reason for Recommendation to VOTE YES

This is the bill patients have been waiting for (though some insurance carriers and big medicine may not agree). The bill encourages a cash pay model without middleman meddling, which will improve affordability, transparency, quality, and competition in healthcare.

It also will encourage people to use independent medical providers who prefer cash payments and generally can provide better services without administrative bloat.

We wish there weren’t any exemptions in this bill, but we’ll take the win if you vote YES on H0529!

Please VOTE YES!

Related

• Rojas Report (provides “clarity, autonomy, and unapologetic strategy for physicians, investors, brokers, and anyone else fed up with a health system that’s bloated, opaque, and allergic to competition”): dutchrojas.substack.com

• Independent Medical Resources List: tinyurl.com/bdfbcrbp

• Idaho Legislature 2026 Bills to Support or Oppose: tinyurl.com/yc2jpkeh