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Replaces subsection (s) of 42 U.S.C. 1395ss to impose guaranteed-issue rules for medicare supplemental policies, add related exceptions, require outreach by the HHS Secretary, and set effective and phase-in dates.
Amends section 1128G of the Social Security Act to (1) modify the compliance date language in subsection (c)(1)(A) to add a six-month submission deadline applicable to information required under new subsection (f)(1), and (2) add a new subsection (f) requiring issuers of Medicare supplemental (Medigap) policies to annually report payments or other transfers of value to agents, brokers, and other third parties and to make subsections (b) through (d) applicable to those issuers and recipients.
Adds new subsections (d), (e), and (f) to 42 U.S.C. 1395b-2 requiring the Secretary (via CMS) to ensure the Medicare Plan Finder website provides specified provider network, cost, and Medigap guarantee information; to conduct reviews and updates; and to solicit and incorporate public comment and consumer testing.
Conforming amendment to add the new subsection (aa) to the list of subsections referenced in paragraph (o)(1).
Amends the 'policy' clause of 42 U.S.C. 1395ss(r)(1)(A) to specify medical loss ratio (MLR) percentage requirements for group and individual policies for periods before and on/after January 1, 2026, and to incorporate NAIC recommendations for percentages on or after that date.
This bill reforms Medigap (Medicare Supplement) so it’s easier to buy, easier to compare, and fairer in pricing. Insurers could not deny you a policy or charge you more because of your health, past claims, or genetic information, and they could not use waiting periods for preexisting conditions. These protections start with policies effective on or after January 1, 2026, with an outreach plan to tell people about the changes and the option to phase in through January 1, 2031 .
Insurers must spend a minimum share of premiums on members’ benefits: before 2026, at least 75% for group policies and 65% for individual policies; from 2026 on, at least those amounts and any higher level recommended by insurance regulators. The bill also limits price discrimination: no age-based pricing, no pricing that makes it hard for people who qualify for Medicare for reasons other than age to get a policy, and no setting premiums for only parts of a county. These new standards apply to people who first get Part A or enroll in Part B on or after January 1, 2026 .
Medicare’s Plan Finder website must show clearer information, like provider networks, out-of-pocket cost estimates, and state rules on guaranteed issue before 2026, and add better comparison tools (sorting premiums, explaining plan value, insurer financial stability, and inflation data). Updates must be consumer-tested and take public comments . The bill restores access to first‑dollar Medigap coverage by removing a past restriction, and it requires Medigap insurers to report yearly what they pay agents and brokers, increasing transparency for shoppers.
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.
Introduced January 22, 2025 by Lloyd Alton Doggett · Last progress January 22, 2025
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.
Introduced in House