Sponsors (44)
The bill expands access, anti‑discrimination protections, and plan transparency for Medigap consumers—particularly beneficiaries with preexisting conditions and older enrollees—but raises the risk of higher premiums, reduced plan variety, and increased implementation and regulatory costs that could be passed onto consumers or taxpayers.
Medicare beneficiaries (including people with preexisting conditions and seniors) can obtain Medigap coverage without medical underwriting, cannot be denied or subjected to preexisting-condition waiting periods, and can enroll year‑round, improving access to supplemental coverage.
Medicare enrollees who first join Medicare on/after Jan 1, 2026 will not face age‑based premium increases and premiums must be uniform within defined geographic areas, improving affordability and preventing local premium discrimination for older beneficiaries.
All Medicare beneficiaries get substantially better transparency—side‑by‑side price and network comparisons, issuer financial stability and inflation data, and public reporting of payments to Medigap brokers—helping consumers compare plans and spot conflicts of interest.
Medicare beneficiaries and taxpayers may face higher Medigap premiums because issuers are likely to raise prices to offset guaranteed‑issue rules, bans on age rating and genetic underwriting, higher MLRs, and added reporting obligations.
Some consumers may see fewer plan choices or loss of employer‑group Medigap options as insurers narrow offerings or exit segments to manage new pricing and compliance pressures.
The bill increases regulatory uncertainty and reduces state flexibility by relying on NAIC recommendations, imposing uniform model‑rule dates, and changing statutory standards—potentially creating uneven outcomes across states and a difficult multi‑year transition for regulators and brokers.
Based on analysis of 7 sections of legislative text.
Requires guaranteed-issue Medigap coverage, bans many pricing/enrollment restrictions, ties MLR minimums to NAIC advice, expands CMS Plan Finder info, and adds broker payment reporting.
Introduced January 22, 2025 by Lloyd Alton Doggett · Last progress January 22, 2025
Requires guaranteed-issue rules for Medicare supplemental (Medigap) policies so insurers cannot deny coverage, charge differently, or exclude preexisting conditions based on health status, and bans many enrollment waiting periods. It ties Medigap medical-loss-ratio minimums to recommendations from the National Association of Insurance Commissioners (NAIC), directs the NAIC to revise model standards to forbid age or area-based premium discrimination, expands consumer information on the CMS Plan Finder about Medigap benefits and costs, removes an existing statutory subsection from the Medigap certification rules, and adds annual broker/agent payment reporting for Medigap issuers. Most consumer-facing changes take effect January 1, 2026 (with limited phased implementation allowed through January 1, 2031); broker reporting must begin within 12 months after enactment. The bill affects Medicare beneficiaries, insurers and their agents, state insurance regulators, and CMS operations and data displays.