Sponsors (45)
The bill substantially expands access, fairness, and transparency in Medigap coverage for Medicare beneficiaries but increases regulatory complexity, compliance costs, and the risk of higher premiums or reduced plan choices as insurers adjust to new guarantees and reporting requirements.
Medicare beneficiaries, including people with preexisting conditions and seniors, will be able to buy Medigap policies without medical underwriting or preexisting-condition waiting periods, preventing denials or exclusions based on health or genetic history.
Medicare beneficiaries will get much clearer, comparable information (side-by-side premiums, networks, issuer stability, inflation data, and state guaranteed-issue rules) and more transparency about payments to brokers, making it easier to compare plans and spot conflicts of interest.
People newly enrolling in Medicare (on/after Jan 1, 2026) and beneficiaries across counties will face fairer, more uniform pricing because age-based premium increases are prohibited for new enrollees and insurers cannot charge different premiums within parts of a county.
Many Medicare beneficiaries (and taxpayers) could face higher premiums because insurers may raise rates to offset guaranteed-issue rules, MLR changes, reporting costs, and other new requirements.
Some beneficiaries could lose plan options or see reduced employer-group offerings as insurers narrow product lines, change offerings, or exit markets in response to new pricing, underwriting, or MLR rules.
Implementation and transition complexity (multi-year phase-ins, new reporting, and data collection) could create confusion for beneficiaries, brokers, state regulators, and issuers and increase administrative burden for CMS and states.
Based on analysis of 7 sections of legislative text.
Guarantees issue of Medigap policies, tightens pricing/MLR rules tied to NAIC, requires broker payment reporting, and improves Plan Finder transparency, mainly effective 2026–2031.
Official title: To amend title XVIII of the Social Security Act to provide for certain reforms with respect to medicare supplemental health insurance policies.
Introduced January 22, 2025 by Lloyd Alton Doggett · Last progress January 22, 2025
Requires guaranteed-issue protections for Medicare supplemental (Medigap) policies, bans many forms of underwriting and preexisting-condition exclusions, and directs HHS and the NAIC to tighten premium-pricing rules. It also raises minimum medical loss ratio standards tied to NAIC recommendations, requires broker payment reporting, removes an existing statutory subsection, and upgrades consumer information on the CMS Plan Finder. Most substantive changes apply to Medigap policies effective on or after January 1, 2026, with HHS allowed to phase in implementation but required to complete the phase-in by January 1, 2031. The bill affects insurers, state regulators, Medicare beneficiaries (especially new enrollees), and entities that sell Medigap coverage like brokers and agents.