[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 610 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 610
To amend title XVIII of the Social Security Act to provide for certain
reforms with respect to medicare supplemental health insurance
policies.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 22, 2025
Mr. Doggett (for himself, Mr. Bishop, Mr. Carson, Mr. Casar, Mr.
Casten, Ms. Chu, Mr. Cleaver, Mr. Cohen, Ms. DeLauro, Mrs. Dingell, Mr.
Espaillat, Mrs. Fletcher, Mr. Garamendi, Ms. Garcia of Texas, Mr.
Grijalva, Ms. Jayapal, Mr. Johnson of Georgia, Ms. Kaptur, Mr. Khanna,
Ms. Lee of Pennsylvania, Ms. Norton, Ms. Ocasio-Cortez, Ms. Pressley,
Mrs. Ramirez, Ms. Schakowsky, Mr. Sherman, Mr. Takano, Mr. Tonko, Mr.
Veasey, Mrs. Watson Coleman, Ms. Williams of Georgia, and Mr. Garcia of
Illinois) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for certain
reforms with respect to medicare supplemental health insurance
policies.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Close the Medigap Act of 2025''.
SEC. 2. GUARANTEED ISSUE.
(a) In General.--Section 1882(s) of the Social Security Act (42
U.S.C. 1395ss(s)) is amended to read as follows:
``(s)(1) Subject to paragraph (2), the issuer of a medicare
supplemental policy may not, in the case of an individual entitled to
benefits under part A and enrolled under part B--
``(A) deny or condition the issuance or effectiveness of a
medicare supplemental policy, or discriminate in the pricing of
the policy, because of health status, claims experience,
receipt of health care, or medical condition;
``(B) exclude benefits based on a preexisting condition;
``(C) provide any time period applicable to preexisting
conditions, waiting periods, elimination periods, and
probationary periods for any benefit;
``(D) deny or condition the issuance or effectiveness of
the policy (including the imposition of any exclusion of
benefits under the policy based on a preexisting condition) or
discriminate in the pricing of the policy (including the
adjustment of premium rates) of an individual on the basis of
the genetic information with respect to such individual;
``(E) deny or condition the issuance or effectiveness of a
medicare supplemental policy that is offered and is available
for issuance to new enrollees by such issuer; or
``(F) establish any period limiting enrollment under a
medicare supplemental policy to such period for any individual.
``(2) Paragraph (1) shall not apply to an individual entitled to
benefits under part A solely by reason of section 226A.
``(3) Nothing in this subsection or in subparagraph (A) or (B) of
subsection (x)(2) shall be construed to limit the ability of an issuer
of a medicare supplemental policy from, to the extent otherwise
permitted under this title--
``(A) denying or conditioning the issuance or effectiveness
of the policy or increasing the premium for an employer based
on the manifestation of a disease or disorder of an individual
who is covered under the policy; or
``(B) increasing the premium for any policy issued to an
individual based on the manifestation of a disease or disorder
of an individual who is covered under the policy (in such case,
the manifestation of a disease or disorder in one individual
cannot also be used as genetic information about other group
members.''.
(b) Outreach Plan.--
(1) In general.--The Secretary of Health and Human Services
shall develop an outreach plan to notify individuals entitled
to benefits under part A or enrolled under part B of title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) of
the effects of the amendment made by subsection (a).
(2) Consultation.--In implementing the outreach plan
developed under paragraph (1), the Secretary shall consult with
consumer advocates, brokers, insurers, the National Association
of Insurance Commissioners, and State Health Insurance
Assistance Programs.
(c) Effective Date; Phase-In Authority.--
(1) Effective date.--Subject to paragraph (2), the
amendment made by subsection (a) shall apply to medicare
supplemental policies effective on or after January 1, 2026.
(2) Phase-in authority.--
(A) In general.--Subject to subparagraph (B), the
Secretary of Health and Human Services may phase in the
implementation of the amendment made under subsection
(a) (with such phase-in beginning on or after January
1, 2026) in such manner as the Secretary determines
appropriate in order to minimize any adverse impact on
individuals enrolled under a medicare supplemental
policy.
(B) Phase-in period may not exceed 5 years.--The
Secretary of Health and Human Services shall ensure
that the amendment made by subsection (a) is fully
implemented by not later than January 1, 2031.
SEC. 3. MEDICAL LOSS RATIO.
Section 1882(r)(1)(A) of the Social Security Act (42 U.S.C.
1395ss(r)(1)(A)) is amended--
(1) by inserting ``and periodically reviewed'' after
``developed''; and
(2) by striking ``policy, at least 75 percent of the
aggregate amount of premiums collected in the case of group
policies and at least 65 percent in the case of individual
policies; and'' and inserting the following: ``policy--
``(i) with respect to periods beginning before
January 1, 2026, at least 75 percent of the aggregate
amount of premiums collected in the case of group
policies and at least 65 percent in the case of
individual policies; and
``(ii) with respect to periods beginning on or
after January 1, 2026, a percent of the aggregate
amount of premiums collected that, in the case of group
policies or individual policies, as applicable, is
equal to or greater than both--
``(I) the applicable percent specified in
clause (i) with respect to such policies; and
``(II) such percent as the National
Association of Insurance Commissioners may
recommend to the Secretary with respect to such
policies for purposes of this paragraph; and''.
SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION.
(a) In General.--Section 1882 of the Social Security Act (42 U.S.C.
1395ss), as amended by section 6, is further amended by adding at the
end the following new subsection:
``(aa) Development of New Standards Relating to Pricing
Discrimination.--
``(1) In general.--The Secretary shall request the National
Association of Insurance Commissioners to review and revise the
standards for all benefit packages under subsection (p)(1),
including the core benefit package, in order to provide
coverage consistent with paragraph (2). Such revisions shall be
made consistent with the rules applicable under subsection
(p)(1)(E) (with the reference to the `1991 NAIC Model
Regulation' deemed a reference to the NAIC Model Regulation as
most recently updated by the National Association of Insurance
Commissioners to reflect previous changes in law and the
reference to `date of enactment of this subsection' deemed a
reference to the date of enactment of this subsection).
``(2) Changes in cost-sharing described.--Under the revised
standards, coverage shall not be available under a Medicare
supplemental insurance policy unless the issuer of the policy,
in addition to conforming to the other applicable requirements
of this section--
``(A) does not discriminate in the pricing of the
policy because of the age of the individual to whom the
policy is issued;
``(B) does not, to an extent that jeopardizes the
access to such policy for individuals who are eligible
to participate in the program under this title because
the individuals are individuals described in paragraph
(2) or (3) of section 1811, discriminate in the pricing
of the policy because the individual to whom the policy
is issued is so eligible to participate in such program
because the individual is an individual so described in
such a paragraph; and
``(C) does not establish premiums applicable under
such policy on a basis that would apply to a portion
of, but not the entirety of, a county or equivalent
area specified by the Secretary.
``(3) Application date.--The revised standards shall apply
to benefit packages sold, issued, or renewed under this section
to individuals who first become entitled to benefits under part
A or first enrolls in part B on or after January 1, 2026.''.
(b) Conforming Amendment.--Section 1882(o)(1) of such Act (42
U.S.C. 1395ss(o)(1)) is amended by striking ``, and (y)'' and inserting
``(y), and (aa)''.
SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDICARE PLAN FINDER
WEBSITE.
Section 1804 of the Social Security Act (42 U.S.C. 1395b-2) is
amended by adding at the end the following new subsections:
``(d) In the case that the Secretary provides for a Medicare plan
finder internet website of the Centers for Medicare & Medicaid Services
(or a successor website), the Secretary shall, with respect to such
website and in accordance with subsection (f)--
``(1) make available on such website--
``(A) access to provider networks in order to
provide to individuals entitled to benefits under part
A or enrolled under part B information to assist such
individuals in understanding the restrictions on
providers and potential costs entailed by their
decisions regarding enrollment under parts A and B,
under part C, and in medicare supplemental policies
under section 1882;
``(B) a review of out-of-pocket expenditures,
including deductibles, copayments, coinsurance, monthly
premiums, and estimated annual out-of-pocket costs,
displayed overall and by components, based on the best
available information as determined by the Secretary;
and
``(C) during the period prior to January 1, 2026,
information regarding the rules that, in each State,
pertain to guaranteed issue of medicare supplemental
health insurance policies prior to implementation of
the provisions of the Close the Medigap Act of 2025
and, in the case that a State has no such rules
pertaining to guaranteed issue of such policies, clear
language explaining the implications of such lack of
rules for individuals with pre-existing conditions;
``(2) not later than January 1, 2026, and periodically
thereafter, perform a review of such website in order to ensure
that such website makes available to individuals entitled to
benefits under part A or enrolled under part B the information
that the Secretary determines is necessary for such individuals
to make informed choices regarding their options under the
program under this title; and
``(3) not later than 12 months after the last day of each
period for the request for information under subsection (e),
update such website, taking into consideration the information
collected pursuant to such subsection, to clarify the
presentation of consumer options for medicare supplemental
health insurance policy options, including by presenting such
information in a manner calculated to be understood by the
average consumer and in a manner that--
``(A) improves consumer access to information
regarding the applicable premiums under such policy
options as of the date on which such website is so
updated;
``(B) facilitates consumers' ability to compare and
sort policy options and premium information across plan
offerings in a given location;
``(C) clarifies and explains differences in policy
value;
``(D) rates and explains the financial stability of
issuers of such policies;
``(E) provides data on the inflation rate of
different policies;
``(F) provides information regarding the guaranteed
issue requirements that apply to medicare supplemental
health insurance policies under section 1882(s)(3); and
``(G) includes such general information as is
determined by the Secretary to be necessary for
individuals entitled to benefits under part A or
enrolled under part B to understand costs under MA
plans available pursuant to part C and prescription
drug plans available pursuant to part D.
``(e) Not later than 6 months after the date of the enactment of
this subsection and beginning on December 7 of each year thereafter,
the Secretary of Health and Human Services shall provide an opportunity
for public comment during which the Secretary requests information,
including recommendations, from stakeholders regarding potential
improvements to the presentation of medicare supplemental health
insurance policy options under section 1882 on the Medicare plan finder
internet website of the Centers for Medicare & Medicaid Services (or a
successor website).
``(f) With respect to any information that the Secretary makes
available on the Medicare plan finder internet website of the Centers
for Medicare & Medicaid Services (or a successor website) pursuant to
subsection (d), the Secretary shall, prior to making such information
available--
``(1) provide, in consultation with the National
Association of Insurance Commissioners, an opportunity for
consumer testing of such information;
``(2) share the results of such consumer testing of such
information with interested stakeholders; and
``(3) provide a 60-day public comment period with respect
to such information.''.
SEC. 6. RESTORING ACCESS TO FIRST-DOLLAR MEDIGAP COVERAGE.
Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is
amended by striking subsection (z).
SEC. 7. BROKER TRANSPARENCY.
Section 1128G of the Social Security Act (42 U.S.C. 1320a-7h) is
amended--
(1) in subsection (c)(1)(A), by striking ``2011,'' and
inserting ``2011 (or, with respect to information required to
be submitted under subsection (f)(1), not later than six months
after the date of the enactment of such subsection),''; and
(2) by adding at the end the following new subsection:
``(f) Application to Medigap Insurance Brokers.--
``(1) In general.--Beginning not later than 12 months after
the date of enactment of this subsection, each issuer of a
medicare supplemental health insurance policy shall annually
submit to the Secretary a report regarding payments or other
transfers of value made during the previous year to agents,
brokers, and other third parties representing such policy. Each
such report shall include the following information, with
respect to such a payment or other transfer of value:
``(A) The name of the recipient of the payment or
other transfer of value.
``(B) The business address of the recipient.
``(C) The amount of the payment or other transfer
of value.
``(D) The dates on which the payment or transfer of
value was provided.
``(E) A description of the form of the payment or
transfer of value.
``(F) Any other categories of information the
Secretary determines appropriate.
``(2) Application of transparency system.--The provisions
of subsections (b) through (d) shall apply to an issuer
described in paragraph (1), information required to be reported
under such paragraph, and agents, brokers, and other third
parties described in such paragraph in the same manner and to
the same extent as such provisions apply to an applicable
manufacturer, information required to be reported under
subsection (a), and a covered recipient.''.
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