Sponsors (16)
The bill trades reduced excess Medicare Advantage payments and taxpayer savings for a risk of narrower plan availability and benefits—potentially disrupting coverage and access for some Medicare beneficiaries.
Taxpayers and Medicare beneficiaries: the bill discourages Medicare Advantage plans from receiving payments above the cost of Original Medicare, reducing excess federal spending on MA payments and protecting federal finances.
Medicare beneficiaries: the bill reduces the risk that plans paid above Original Medicare costs will stay open only temporarily (by barring such plans from new enrollments the next year), which lowers the chance of overpayment-driven plan instability.
Medicare beneficiaries: some could lose access to their Medicare Advantage plan if affected plans stop new enrollments and later withdraw or scale back offerings, disrupting continuity of care.
Medicare beneficiaries: restricting new enrollments could reduce competition and choice in some local markets, potentially leading to higher premiums or fewer plan options for remaining enrollees.
Medicare beneficiaries and hospitals/health systems: insurers may respond by narrowing benefits or provider networks to lower costs, which could worsen access to services for current enrollees and strain providers.
Based on analysis of 2 sections of legislative text.
Bars enrollment and reenrollment into MA plans for a plan year after CMS finds prior-year MA payments exceeded Original Medicare costs; SNPs are exempt.
Official title: 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.
Introduced November 18, 2025 by Mark Pocan · Last progress November 18, 2025
Prohibits enrollment and reenrollment into any Medicare Advantage (MA) plan for the plan year immediately following any year in which CMS finds that the plan’s average monthly payment exceeded the average monthly cost of providing the same coverage under Original Medicare Parts A and B. The restriction applies one year after enactment and does not apply to specialized Medicare Advantage SNP plans.