119-hr610

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 610 Introduced in House

    (IH) ]

<DOC>

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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