Questions, answered straight

No. HEALTH5 is a proposal. It would take new federal legislation passed by Congress and signed into law, followed by CMS rules, to create it. This site advocates for that legislation. See For lawmakers.

Qualified U.S. citizens. Other eligible persons could purchase HEALTH5 coverage under rules set by Congress and CMS.

The five core benefits: medical (health), dental, vision, hearing and outpatient prescription drugs.

If your doctor participated, yes, and you wouldn’t need to check networks. HEALTH5 would have no insurer-specific networks for covered care. Participating providers would accept the standard rate as payment in full, and balance billing would be prohibited.

HEALTH5 would cover up to 120 days a year of medically necessary skilled nursing, rehabilitation, qualified home health and habilitation. Indefinite custodial long-term care wouldn’t be part of the core benefit. It could be covered by supplemental or long-term-care insurance, Medicaid eligibility or personal resources.

No. Once enrolled you would generally stay with your assigned insurer for five years, and the insurer couldn’t end coverage because your health worsened or your claims were high. Exceptions would cover things like insurer insolvency, moving, eligibility changes and major family changes.

The proposed standard contribution is $125 a month per healthy enrollee. Under UHC-0 there would be no deductibles, copays or coinsurance for covered care. Under UHC-5000 your yearly out-of-pocket cost for covered services would be capped at $5,000, in exchange for a lower expected premium.

No. $832 total funding and $125 contribution are per-person figures. Family costs would use age and dependent factors set by CMS, because children usually cost less to cover than adults.

No for the vast majority of conditions. The risk score would be used only to balance members across insurers, not to set your contribution. The proposal does include a narrow, heavily safeguarded category, which would need its own legislation, for conditions caused intentionally or negligently, with independent review, appeal rights, a cap on any adjustment and automatic expiration after 60 months.

No. That number would be total system funding, most of which is already spent today. In 2024 the U.S. spent $5.3 trillion on health, including $1.118 trillion through Medicare, $931.7 billion through Medicaid and $1.645 trillion through private insurance (CMS). HEALTH5 would redirect those dollars and forbid counting them twice. How the $707 balance is split among employers, federal and state governments is a decision for Congress.

Employers would stay involved. In the working model the employee would pay $125 and the employer $707 a month. Employers could keep offering HEALTH5 plans that meet the national standard. The proposal’s rubric applies the employer share to businesses with 20 or more employees. For comparison, employers paid about $7,885 a year of the average $9,325 single premium in 2025 (KFF), close to the $8,484 a year HEALTH5 would ask.

No. Private insurers would administer HEALTH5 and compete on service, efficiency, technology and fraud control. They would also keep selling supplemental products. What would change is that they no longer compete by building narrow networks or avoiding sick members.

The proposal targets about 500,000 permanent administrative jobs and proposes a temporary Workforce Transition Corps that retrains affected workers to build the automation, then helps them move into new roles. See Jobs and the workforce.

Not yet, and we say so plainly. $832 is a ceiling on average funding per person, set to match the Central States benchmark. It is close to today’s average employer single premium of $9,325 a year, about $777 a month (KFF 2025), but HEALTH5 would cover more. A full actuarial model has to test whether $9,984 a year per person can fund all five benefits, extended care, administration and reserves. See The math.

It could, which is why the proposal includes national access standards, tracking of days to appointment, and investments in residencies, rural incentives, telehealth and advanced-practice clinicians.

We don’t claim a fixed administrative-savings percentage. Reaching the target means savings across hospitals, physicians, drugs and administration, and every one has to be shown with data.