[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6112 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 6112

 To amend title XVIII of the Social Security Act to establish certain 
   requirements with respect to the average monthly cost to provide 
        coverage to an enrollee under Medicare Advantage plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 18, 2025

    Mr. Pocan (for himself, Mr. Carson, Mr. Cohen, Ms. DeLauro, Mr. 
 Doggett, Ms. Jayapal, Mr. Khanna, Ms. Norton, Ms. Ocasio-Cortez, Ms. 
    Schakowsky, Mr. Takano, Mr. Thanedar, Ms. Tlaib, and Ms. Omar) 
 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 establish certain 
   requirements with respect to the average monthly cost to provide 
        coverage to an enrollee under Medicare Advantage plans.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. ESTABLISHING REQUIREMENTS WITH RESPECT TO AVERAGE MONTHLY 
              COST TO PROVIDE COVERAGE UNDER MEDICARE ADVANTAGE PLANS.

    Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) 
is amended by adding at the end the following new paragraph:
            ``(6) Requirement on average monthly cost to provide 
        coverage.--
                    ``(A) In general.--Beginning with plan years 
                beginning on or after the date that is 1 year after the 
                date of the enactment of this paragraph, if the 
                Secretary determines that, with respect to a plan year 
                and a Medicare advantage plan, the average monthly 
                payment amount under section 1853 with respect to 
                coverage of individuals enrolled in such Medicare 
                Advantage plan for such plan year exceeds the average 
                monthly cost to provide coverage for individuals 
                enrolled in the original Medicare fee-for-service 
                program under parts A and B for such plan year, the 
                Secretary shall not permit any individual to enroll or 
                reenroll in such plan for the plan year immediately 
                following such plan year.
                    ``(B) Exception.--Subparagraph (A) shall not apply 
                with respect to a specialized MA plan for special needs 
                individuals.''.
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