Sponsors (16)
The bill aims to curb excess Medicare Advantage payments to save taxpayer dollars and limit unstable plan growth, but it risks reducing plan availability and access for current MA enrollees—potentially causing plan exits, narrower benefits/networks, and higher costs for some beneficiaries.
Taxpayers and Medicare beneficiaries: the bill discourages Medicare Advantage plans from being paid more than Original Medicare, which should reduce excess federal spending on MA payments and protect taxpayer dollars.
Medicare beneficiaries: by barring plans paid above Original Medicare from taking new enrollments the following year, the bill reduces the risk that overpayment-driven plan instability will persist or expand, lowering the chance of sudden plan failures tied to unsustainable payment practices.
Medicare beneficiaries: beneficiaries enrolled in affected MA plans could lose access to their plan if a plan stops new enrollments and later withdraws or reduces offerings, disrupting continuity of care.
Medicare beneficiaries and providers: insurers may respond to enrollment limits by narrowing covered benefits or provider networks to lower costs, which can worsen access to services for current enrollees and strain hospitals and health systems.
Medicare beneficiaries: limiting new enrollments for certain plans could reduce competition and choice in some local markets, potentially leading to higher premiums or fewer plan options for remaining enrollees.
Based on analysis of 2 sections of legislative text.
Prevents enrollment (including reenrollment) into an MA plan for the year after CMS finds the plan's average monthly payment exceeded Original Medicare's average monthly cost; SNPs are exempt.
Introduced November 18, 2025 by Mark Pocan · Last progress November 18, 2025
Prohibits enrollment (including reenrollment) into any Medicare Advantage (MA) plan for the plan year immediately after a year in which the Secretary finds that the plan’s average monthly payment exceeded the average monthly cost to provide the same coverage under Original Medicare Parts A and B. The prohibition does not apply to Special Needs Plans (SNPs) and takes effect for plan years beginning one year after enactment.