I
119THCONGRESS
1
STSESSION H. R. 610
To amend title XVIII of the Social Security Act to provide for certain
reforms with respect to medicare supplemental health insurance policies.
IN THE HOUSE OF REPRESENTATIVES
JANUARY22, 2025
Mr. D
OGGETT(for himself, Mr. BISHOP, Mr. CARSON, Mr. CASAR, Mr.
C
ASTEN, Ms. CHU, Mr. CLEAVER, Mr. COHEN, Ms. DELAURO, Mrs. DIN-
GELL, Mr. ESPAILLAT, Mrs. FLETCHER, Mr. GARAMENDI, Ms. GARCIA
of Texas, Mr. G
RIJALVA, Ms. JAYAPAL, Mr. JOHNSONof Georgia, Ms.
K
APTUR, Mr. KHANNA, Ms. LEEof Pennsylvania, Ms. NORTON, Ms.
O
CASIO-CORTEZ, Ms. PRESSLEY, Mrs. RAMIREZ, Ms. SCHAKOWSKY, Mr.
S
HERMAN, Mr. TAKANO, Mr. TONKO, Mr. VEASEY, Mrs. WATSONCOLE-
MAN, Ms. WILLIAMSof Georgia, and Mr. GARCI´Aof Illinois) introduced
the following bill; which was 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 com-
mittee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for certain reforms with respect to medicare supple-
mental health insurance policies.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
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SECTION 1. SHORT TITLE. 1
This Act may be cited as the ‘‘Close the Medigap Act 2
of 2025’’. 3
SEC. 2. GUARANTEED ISSUE. 4
(a) I
NGENERAL.—Section 1882(s) of the Social Se-5
curity Act (42 U.S.C. 1395ss(s)) is amended to read as 6
follows: 7
‘‘(s)(1) Subject to paragraph (2), the issuer of a 8
medicare supplemental policy may not, in the case of an 9
individual entitled to benefits under part A and enrolled 10
under part B— 11
‘‘(A) deny or condition the issuance or effective-12
ness of a medicare supplemental policy, or discrimi-13
nate in the pricing of the policy, because of health 14
status, claims experience, receipt of health care, or 15
medical condition; 16
‘‘(B) exclude benefits based on a preexisting 17
condition; 18
‘‘(C) provide any time period applicable to pre-19
existing conditions, waiting periods, elimination peri-20
ods, and probationary periods for any benefit; 21
‘‘(D) deny or condition the issuance or effec-22
tiveness of the policy (including the imposition of 23
any exclusion of benefits under the policy based on 24
a preexisting condition) or discriminate in the pric-25
ing of the policy (including the adjustment of pre-26
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mium rates) of an individual on the basis of the ge-1
netic information with respect to such individual; 2
‘‘(E) deny or condition the issuance or effective-3
ness of a medicare supplemental policy that is of-4
fered and is available for issuance to new enrollees 5
by such issuer; or 6
‘‘(F) establish any period limiting enrollment 7
under a medicare supplemental policy to such period 8
for any individual. 9
‘‘(2) Paragraph (1) shall not apply to an individual 10
entitled to benefits under part A solely by reason of section 11
226A. 12
‘‘(3) Nothing in this subsection or in subparagraph 13
(A) or (B) of subsection (x)(2) shall be construed to limit 14
the ability of an issuer of a medicare supplemental policy 15
from, to the extent otherwise permitted under this title— 16
‘‘(A) denying or conditioning the issuance or ef-17
fectiveness of the policy or increasing the premium 18
for an employer based on the manifestation of a dis-19
ease or disorder of an individual who is covered 20
under the policy; or 21
‘‘(B) increasing the premium for any policy 22
issued to an individual based on the manifestation of 23
a disease or disorder of an individual who is covered 24
under the policy (in such case, the manifestation of 25
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a disease or disorder in one individual cannot also 1
be used as genetic information about other group 2
members.’’. 3
(b) O
UTREACHPLAN.— 4
(1) I
N GENERAL.—The Secretary of Health and 5
Human Services shall develop an outreach plan to 6
notify individuals entitled to benefits under part A 7
or enrolled under part B of title XVIII of the Social 8
Security Act (42 U.S.C. 1395 et seq.) of the effects 9
of the amendment made by subsection (a). 10
(2) C
ONSULTATION.—In implementing the out-11
reach plan developed under paragraph (1), the Sec-12
retary shall consult with consumer advocates, bro-13
kers, insurers, the National Association of Insurance 14
Commissioners, and State Health Insurance Assist-15
ance Programs. 16
(c) E
FFECTIVEDATE; PHASE-INAUTHORITY.— 17
(1) E
FFECTIVE DATE.—Subject to paragraph 18
(2), the amendment made by subsection (a) shall 19
apply to medicare supplemental policies effective on 20
or after January 1, 2026. 21
(2) P
HASE-IN AUTHORITY.— 22
(A) I
N GENERAL.—Subject to subpara-23
graph (B), the Secretary of Health and Human 24
Services may phase in the implementation of 25
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the amendment made under subsection (a) 1
(with such phase-in beginning on or after Janu-2
ary 1, 2026) in such manner as the Secretary 3
determines appropriate in order to minimize 4
any adverse impact on individuals enrolled 5
under a medicare supplemental policy. 6
(B) P
HASE-IN PERIOD MAY NOT EXCEED 5 7
YEARS.—The Secretary of Health and Human 8
Services shall ensure that the amendment made 9
by subsection (a) is fully implemented by not 10
later than January 1, 2031. 11
SEC. 3. MEDICAL LOSS RATIO. 12
Section 1882(r)(1)(A) of the Social Security Act (42 13
U.S.C. 1395ss(r)(1)(A)) is amended— 14
(1) by inserting ‘‘and periodically reviewed’’ 15
after ‘‘developed’’; and 16
(2) by striking ‘‘policy, at least 75 percent of 17
the aggregate amount of premiums collected in the 18
case of group policies and at least 65 percent in the 19
case of individual policies; and’’ and inserting the 20
following: ‘‘policy— 21
‘‘(i) with respect to periods beginning be-22
fore January 1, 2026, at least 75 percent of the 23
aggregate amount of premiums collected in the 24
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case of group policies and at least 65 percent 1
in the case of individual policies; and 2
‘‘(ii) with respect to periods beginning on 3
or after January 1, 2026, a percent of the ag-4
gregate amount of premiums collected that, in 5
the case of group policies or individual policies, 6
as applicable, is equal to or greater than both— 7
‘‘(I) the applicable percent specified in 8
clause (i) with respect to such policies; and 9
‘‘(II) such percent as the National As-10
sociation of Insurance Commissioners may 11
recommend to the Secretary with respect 12
to such policies for purposes of this para-13
graph; and’’. 14
SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION. 15
(a) I
NGENERAL.—Section 1882 of the Social Secu-16
rity Act (42 U.S.C. 1395ss), as amended by section 6, is 17
further amended by adding at the end the following new 18
subsection: 19
‘‘(aa) D
EVELOPMENT OF NEWSTANDARDSRELAT-20
ING TOPRICINGDISCRIMINATION.— 21
‘‘(1) I
N GENERAL.—The Secretary shall request 22
the National Association of Insurance Commis-23
sioners to review and revise the standards for all 24
benefit packages under subsection (p)(1), including 25
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the core benefit package, in order to provide cov-1
erage consistent with paragraph (2). Such revisions 2
shall be made consistent with the rules applicable 3
under subsection (p)(1)(E) (with the reference to the 4
‘1991 NAIC Model Regulation’ deemed a reference 5
to the NAIC Model Regulation as most recently up-6
dated by the National Association of Insurance 7
Commissioners to reflect previous changes in law 8
and the reference to ‘date of enactment of this sub-9
section’ deemed a reference to the date of enactment 10
of this subsection). 11
‘‘(2) C
HANGES IN COST-SHARING DESCRIBED.— 12
Under the revised standards, coverage shall not be 13
available under a Medicare supplemental insurance 14
policy unless the issuer of the policy, in addition to 15
conforming to the other applicable requirements of 16
this section— 17
‘‘(A) does not discriminate in the pricing 18
of the policy because of the age of the indi-19
vidual to whom the policy is issued; 20
‘‘(B) does not, to an extent that jeopard-21
izes the access to such policy for individuals 22
who are eligible to participate in the program 23
under this title because the individuals are indi-24
viduals described in paragraph (2) or (3) of sec-25
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tion 1811, discriminate in the pricing of the 1
policy because the individual to whom the policy 2
is issued is so eligible to participate in such 3
program because the individual is an individual 4
so described in such a paragraph; and 5
‘‘(C) does not establish premiums applica-6
ble under such policy on a basis that would 7
apply to a portion of, but not the entirety of, 8
a county or equivalent area specified by the 9
Secretary. 10
‘‘(3) A
PPLICATION DATE.—The revised stand-11
ards shall apply to benefit packages sold, issued, or 12
renewed under this section to individuals who first 13
become entitled to benefits under part A or first en-14
rolls in part B on or after January 1, 2026.’’. 15
(b) C
ONFORMINGAMENDMENT.—Section 1882(o)(1) 16
of such Act (42 U.S.C. 1395ss(o)(1)) is amended by strik-17
ing ‘‘, and (y)’’ and inserting ‘‘(y), and (aa)’’. 18
SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDI-19
CARE PLAN FINDER WEBSITE. 20
Section 1804 of the Social Security Act (42 U.S.C. 21
1395b–2) is amended by adding at the end the following 22
new subsections: 23
‘‘(d) In the case that the Secretary provides for a 24
Medicare plan finder internet website of the Centers for 25
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Medicare & Medicaid Services (or a successor website), the 1
Secretary shall, with respect to such website and in ac-2
cordance with subsection (f)— 3
‘‘(1) make available on such website— 4
‘‘(A) access to provider networks in order 5
to provide to individuals entitled to benefits 6
under part A or enrolled under part B informa-7
tion to assist such individuals in understanding 8
the restrictions on providers and potential costs 9
entailed by their decisions regarding enrollment 10
under parts A and B, under part C, and in 11
medicare supplemental policies under section 12
1882; 13
‘‘(B) a review of out-of-pocket expendi-14
tures, including deductibles, copayments, coin-15
surance, monthly premiums, and estimated an-16
nual out-of-pocket costs, displayed overall and 17
by components, based on the best available in-18
formation as determined by the Secretary; and 19
‘‘(C) during the period prior to January 1, 20
2026, information regarding the rules that, in 21
each State, pertain to guaranteed issue of medi-22
care supplemental health insurance policies 23
prior to implementation of the provisions of the 24
Close the Medigap Act of 2025 and, in the case 25
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that a State has no such rules pertaining to 1
guaranteed issue of such policies, clear lan-2
guage explaining the implications of such lack 3
of rules for individuals with pre-existing condi-4
tions; 5
‘‘(2) not later than January 1, 2026, and peri-6
odically thereafter, perform a review of such website 7
in order to ensure that such website makes available 8
to individuals entitled to benefits under part A or 9
enrolled under part B the information that the Sec-10
retary determines is necessary for such individuals 11
to make informed choices regarding their options 12
under the program under this title; and 13
‘‘(3) not later than 12 months after the last 14
day of each period for the request for information 15
under subsection (e), update such website, taking 16
into consideration the information collected pursuant 17
to such subsection, to clarify the presentation of con-18
sumer options for medicare supplemental health in-19
surance policy options, including by presenting such 20
information in a manner calculated to be understood 21
by the average consumer and in a manner that— 22
‘‘(A) improves consumer access to informa-23
tion regarding the applicable premiums under 24
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such policy options as of the date on which such 1
website is so updated; 2
‘‘(B) facilitates consumers’ ability to com-3
pare and sort policy options and premium infor-4
mation across plan offerings in a given location; 5
‘‘(C) clarifies and explains differences in 6
policy value; 7
‘‘(D) rates and explains the financial sta-8
bility of issuers of such policies; 9
‘‘(E) provides data on the inflation rate of 10
different policies; 11
‘‘(F) provides information regarding the 12
guaranteed issue requirements that apply to 13
medicare supplemental health insurance policies 14
under section 1882(s)(3); and 15
‘‘(G) includes such general information as 16
is determined by the Secretary to be necessary 17
for individuals entitled to benefits under part A 18
or enrolled under part B to understand costs 19
under MA plans available pursuant to part C 20
and prescription drug plans available pursuant 21
to part D. 22
‘‘(e) Not later than 6 months after the date of the 23
enactment of this subsection and beginning on December 24
7 of each year thereafter, the Secretary of Health and 25
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Human Services shall provide an opportunity for public 1
comment during which the Secretary requests informa-2
tion, including recommendations, from stakeholders re-3
garding potential improvements to the presentation of 4
medicare supplemental health insurance policy options 5
under section 1882 on the Medicare plan finder internet 6
website of the Centers for Medicare & Medicaid Services 7
(or a successor website). 8
‘‘(f) With respect to any information that the Sec-9
retary makes available on the Medicare plan finder inter-10
net website of the Centers for Medicare & Medicaid Serv-11
ices (or a successor website) pursuant to subsection (d), 12
the Secretary shall, prior to making such information 13
available— 14
‘‘(1) provide, in consultation with the National 15
Association of Insurance Commissioners, an oppor-16
tunity for consumer testing of such information; 17
‘‘(2) share the results of such consumer testing 18
of such information with interested stakeholders; 19
and 20
‘‘(3) provide a 60-day public comment period 21
with respect to such information.’’. 22
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SEC. 6. RESTORING ACCESS TO FIRST-DOLLAR MEDIGAP 1
COVERAGE. 2
Section 1882 of the Social Security Act (42 U.S.C. 3
1395ss) is amended by striking subsection (z). 4
SEC. 7. BROKER TRANSPARENCY. 5
Section 1128G of the Social Security Act (42 U.S.C. 6
1320a–7h) is amended— 7
(1) in subsection (c)(1)(A), by striking ‘‘2011,’’ 8
and inserting ‘‘2011 (or, with respect to information 9
required to be submitted under subsection (f)(1), not 10
later than six months after the date of the enact-11
ment of such subsection),’’; and 12
(2) by adding at the end the following new sub-13
section: 14
‘‘(f) A
PPLICATION TOMEDIGAPINSURANCEBRO-15
KERS.— 16
‘‘(1) I
N GENERAL.—Beginning not later than 17
12 months after the date of enactment of this sub-18
section, each issuer of a medicare supplemental 19
health insurance policy shall annually submit to the 20
Secretary a report regarding payments or other 21
transfers of value made during the previous year to 22
agents, brokers, and other third parties representing 23
such policy. Each such report shall include the fol-24
lowing information, with respect to such a payment 25
or other transfer of value: 26
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‘‘(A) The name of the recipient of the pay-1
ment or other transfer of value. 2
‘‘(B) The business address of the recipient. 3
‘‘(C) The amount of the payment or other 4
transfer of value. 5
‘‘(D) The dates on which the payment or 6
transfer of value was provided. 7
‘‘(E) A description of the form of the pay-8
ment or transfer of value. 9
‘‘(F) Any other categories of information 10
the Secretary determines appropriate. 11
‘‘(2) A
PPLICATION OF TRANSPARENCY SYS -12
TEM.—The provisions of subsections (b) through (d) 13
shall apply to an issuer described in paragraph (1), 14
information required to be reported under such 15
paragraph, and agents, brokers, and other third par-16
ties described in such paragraph in the same manner 17
and to the same extent as such provisions apply to 18
an applicable manufacturer, information required to 19
be reported under subsection (a), and a covered re-20
cipient.’’. 21
Æ
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