Us Congress 2025-2026 Regular Session

Us Congress House Bill HB610 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 610
5	5	To amend title XVIII of the Social Security Act to provide for certain
6	6	reforms with respect to medicare supplemental health insurance policies.
7	7	IN THE HOUSE OF REPRESENTATIVES
8	8	JANUARY22, 2025
9	9	Mr. D
10	10	OGGETT(for himself, Mr. BISHOP, Mr. CARSON, Mr. CASAR, Mr.
11	11	C
12	12	ASTEN, Ms. CHU, Mr. CLEAVER, Mr. COHEN, Ms. DELAURO, Mrs. DIN-
13	13	GELL, Mr. ESPAILLAT, Mrs. FLETCHER, Mr. GARAMENDI, Ms. GARCIA
14	14	of Texas, Mr. G
15	15	RIJALVA, Ms. JAYAPAL, Mr. JOHNSONof Georgia, Ms.
16	16	K
17	17	APTUR, Mr. KHANNA, Ms. LEEof Pennsylvania, Ms. NORTON, Ms.
18	18	O
19	19	CASIO-CORTEZ, Ms. PRESSLEY, Mrs. RAMIREZ, Ms. SCHAKOWSKY, Mr.
20	20	S
21	21	HERMAN, Mr. TAKANO, Mr. TONKO, Mr. VEASEY, Mrs. WATSONCOLE-
22	22	MAN, Ms. WILLIAMSof Georgia, and Mr. GARCI´Aof Illinois) introduced
23	23	the following bill; which was referred to the Committee on Ways and
24	24	Means, and in addition to the Committee on Energy and Commerce, for
25	25	a period to be subsequently determined by the Speaker, in each case for
26	26	consideration of such provisions as fall within the jurisdiction of the com-
27	27	mittee concerned
28	28	A BILL
29	29	To amend title XVIII of the Social Security Act to provide
30	30	for certain reforms with respect to medicare supple-
31	31	mental health insurance policies.
32	32	Be it enacted by the Senate and House of Representa-1
33	33	tives of the United States of America in Congress assembled, 2
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37	37	SECTION 1. SHORT TITLE. 1
38	38	This Act may be cited as the ‘‘Close the Medigap Act 2
39	39	of 2025’’. 3
40	40	SEC. 2. GUARANTEED ISSUE. 4
41	41	(a) I
42	42	NGENERAL.—Section 1882(s) of the Social Se-5
43	43	curity Act (42 U.S.C. 1395ss(s)) is amended to read as 6
44	44	follows: 7
45	45	‘‘(s)(1) Subject to paragraph (2), the issuer of a 8
46	46	medicare supplemental policy may not, in the case of an 9
47	47	individual entitled to benefits under part A and enrolled 10
48	48	under part B— 11
49	49	‘‘(A) deny or condition the issuance or effective-12
50	50	ness of a medicare supplemental policy, or discrimi-13
51	51	nate in the pricing of the policy, because of health 14
52	52	status, claims experience, receipt of health care, or 15
53	53	medical condition; 16
54	54	‘‘(B) exclude benefits based on a preexisting 17
55	55	condition; 18
56	56	‘‘(C) provide any time period applicable to pre-19
57	57	existing conditions, waiting periods, elimination peri-20
58	58	ods, and probationary periods for any benefit; 21
59	59	‘‘(D) deny or condition the issuance or effec-22
60	60	tiveness of the policy (including the imposition of 23
61	61	any exclusion of benefits under the policy based on 24
62	62	a preexisting condition) or discriminate in the pric-25
63	63	ing of the policy (including the adjustment of pre-26
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67	67	mium rates) of an individual on the basis of the ge-1
68	68	netic information with respect to such individual; 2
69	69	‘‘(E) deny or condition the issuance or effective-3
70	70	ness of a medicare supplemental policy that is of-4
71	71	fered and is available for issuance to new enrollees 5
72	72	by such issuer; or 6
73	73	‘‘(F) establish any period limiting enrollment 7
74	74	under a medicare supplemental policy to such period 8
75	75	for any individual. 9
76	76	‘‘(2) Paragraph (1) shall not apply to an individual 10
77	77	entitled to benefits under part A solely by reason of section 11
78	78	226A. 12
79	79	‘‘(3) Nothing in this subsection or in subparagraph 13
80	80	(A) or (B) of subsection (x)(2) shall be construed to limit 14
81	81	the ability of an issuer of a medicare supplemental policy 15
82	82	from, to the extent otherwise permitted under this title— 16
83	83	‘‘(A) denying or conditioning the issuance or ef-17
84	84	fectiveness of the policy or increasing the premium 18
85	85	for an employer based on the manifestation of a dis-19
86	86	ease or disorder of an individual who is covered 20
87	87	under the policy; or 21
88	88	‘‘(B) increasing the premium for any policy 22
89	89	issued to an individual based on the manifestation of 23
90	90	a disease or disorder of an individual who is covered 24
91	91	under the policy (in such case, the manifestation of 25
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95	95	a disease or disorder in one individual cannot also 1
96	96	be used as genetic information about other group 2
97	97	members.’’. 3
98	98	(b) O
99	99	UTREACHPLAN.— 4
100	100	(1) I
101	101	N GENERAL.—The Secretary of Health and 5
102	102	Human Services shall develop an outreach plan to 6
103	103	notify individuals entitled to benefits under part A 7
104	104	or enrolled under part B of title XVIII of the Social 8
105	105	Security Act (42 U.S.C. 1395 et seq.) of the effects 9
106	106	of the amendment made by subsection (a). 10
107	107	(2) C
108	108	ONSULTATION.—In implementing the out-11
109	109	reach plan developed under paragraph (1), the Sec-12
110	110	retary shall consult with consumer advocates, bro-13
111	111	kers, insurers, the National Association of Insurance 14
112	112	Commissioners, and State Health Insurance Assist-15
113	113	ance Programs. 16
114	114	(c) E
115	115	FFECTIVEDATE; PHASE-INAUTHORITY.— 17
116	116	(1) E
117	117	FFECTIVE DATE.—Subject to paragraph 18
118	118	(2), the amendment made by subsection (a) shall 19
119	119	apply to medicare supplemental policies effective on 20
120	120	or after January 1, 2026. 21
121	121	(2) P
122	122	HASE-IN AUTHORITY.— 22
123	123	(A) I
124	124	N GENERAL.—Subject to subpara-23
125	125	graph (B), the Secretary of Health and Human 24
126	126	Services may phase in the implementation of 25
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130	130	the amendment made under subsection (a) 1
131	131	(with such phase-in beginning on or after Janu-2
132	132	ary 1, 2026) in such manner as the Secretary 3
133	133	determines appropriate in order to minimize 4
134	134	any adverse impact on individuals enrolled 5
135	135	under a medicare supplemental policy. 6
136	136	(B) P
137	137	HASE-IN PERIOD MAY NOT EXCEED 5 7
138	138	YEARS.—The Secretary of Health and Human 8
139	139	Services shall ensure that the amendment made 9
140	140	by subsection (a) is fully implemented by not 10
141	141	later than January 1, 2031. 11
142	142	SEC. 3. MEDICAL LOSS RATIO. 12
143	143	Section 1882(r)(1)(A) of the Social Security Act (42 13
144	144	U.S.C. 1395ss(r)(1)(A)) is amended— 14
145	145	(1) by inserting ‘‘and periodically reviewed’’ 15
146	146	after ‘‘developed’’; and 16
147	147	(2) by striking ‘‘policy, at least 75 percent of 17
148	148	the aggregate amount of premiums collected in the 18
149	149	case of group policies and at least 65 percent in the 19
150	150	case of individual policies; and’’ and inserting the 20
151	151	following: ‘‘policy— 21
152	152	‘‘(i) with respect to periods beginning be-22
153	153	fore January 1, 2026, at least 75 percent of the 23
154	154	aggregate amount of premiums collected in the 24
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158	158	case of group policies and at least 65 percent 1
159	159	in the case of individual policies; and 2
160	160	‘‘(ii) with respect to periods beginning on 3
161	161	or after January 1, 2026, a percent of the ag-4
162	162	gregate amount of premiums collected that, in 5
163	163	the case of group policies or individual policies, 6
164	164	as applicable, is equal to or greater than both— 7
165	165	‘‘(I) the applicable percent specified in 8
166	166	clause (i) with respect to such policies; and 9
167	167	‘‘(II) such percent as the National As-10
168	168	sociation of Insurance Commissioners may 11
169	169	recommend to the Secretary with respect 12
170	170	to such policies for purposes of this para-13
171	171	graph; and’’. 14
172	172	SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION. 15
173	173	(a) I
174	174	NGENERAL.—Section 1882 of the Social Secu-16
175	175	rity Act (42 U.S.C. 1395ss), as amended by section 6, is 17
176	176	further amended by adding at the end the following new 18
177	177	subsection: 19
178	178	‘‘(aa) D
179	179	EVELOPMENT OF NEWSTANDARDSRELAT-20
180	180	ING TOPRICINGDISCRIMINATION.— 21
181	181	‘‘(1) I
182	182	N GENERAL.—The Secretary shall request 22
183	183	the National Association of Insurance Commis-23
184	184	sioners to review and revise the standards for all 24
185	185	benefit packages under subsection (p)(1), including 25
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189	189	the core benefit package, in order to provide cov-1
190	190	erage consistent with paragraph (2). Such revisions 2
191	191	shall be made consistent with the rules applicable 3
192	192	under subsection (p)(1)(E) (with the reference to the 4
193	193	‘1991 NAIC Model Regulation’ deemed a reference 5
194	194	to the NAIC Model Regulation as most recently up-6
195	195	dated by the National Association of Insurance 7
196	196	Commissioners to reflect previous changes in law 8
197	197	and the reference to ‘date of enactment of this sub-9
198	198	section’ deemed a reference to the date of enactment 10
199	199	of this subsection). 11
200	200	‘‘(2) C
201	201	HANGES IN COST-SHARING DESCRIBED.— 12
202	202	Under the revised standards, coverage shall not be 13
203	203	available under a Medicare supplemental insurance 14
204	204	policy unless the issuer of the policy, in addition to 15
205	205	conforming to the other applicable requirements of 16
206	206	this section— 17
207	207	‘‘(A) does not discriminate in the pricing 18
208	208	of the policy because of the age of the indi-19
209	209	vidual to whom the policy is issued; 20
210	210	‘‘(B) does not, to an extent that jeopard-21
211	211	izes the access to such policy for individuals 22
212	212	who are eligible to participate in the program 23
213	213	under this title because the individuals are indi-24
214	214	viduals described in paragraph (2) or (3) of sec-25
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218	218	tion 1811, discriminate in the pricing of the 1
219	219	policy because the individual to whom the policy 2
220	220	is issued is so eligible to participate in such 3
221	221	program because the individual is an individual 4
222	222	so described in such a paragraph; and 5
223	223	‘‘(C) does not establish premiums applica-6
224	224	ble under such policy on a basis that would 7
225	225	apply to a portion of, but not the entirety of, 8
226	226	a county or equivalent area specified by the 9
227	227	Secretary. 10
228	228	‘‘(3) A
229	229	PPLICATION DATE.—The revised stand-11
230	230	ards shall apply to benefit packages sold, issued, or 12
231	231	renewed under this section to individuals who first 13
232	232	become entitled to benefits under part A or first en-14
233	233	rolls in part B on or after January 1, 2026.’’. 15
234	234	(b) C
235	235	ONFORMINGAMENDMENT.—Section 1882(o)(1) 16
236	236	of such Act (42 U.S.C. 1395ss(o)(1)) is amended by strik-17
237	237	ing ‘‘, and (y)’’ and inserting ‘‘(y), and (aa)’’. 18
238	238	SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDI-19
239	239	CARE PLAN FINDER WEBSITE. 20
240	240	Section 1804 of the Social Security Act (42 U.S.C. 21
241	241	1395b–2) is amended by adding at the end the following 22
242	242	new subsections: 23
243	243	‘‘(d) In the case that the Secretary provides for a 24
244	244	Medicare plan finder internet website of the Centers for 25
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248	248	Medicare & Medicaid Services (or a successor website), the 1
249	249	Secretary shall, with respect to such website and in ac-2
250	250	cordance with subsection (f)— 3
251	251	‘‘(1) make available on such website— 4
252	252	‘‘(A) access to provider networks in order 5
253	253	to provide to individuals entitled to benefits 6
254	254	under part A or enrolled under part B informa-7
255	255	tion to assist such individuals in understanding 8
256	256	the restrictions on providers and potential costs 9
257	257	entailed by their decisions regarding enrollment 10
258	258	under parts A and B, under part C, and in 11
259	259	medicare supplemental policies under section 12
260	260	1882; 13
261	261	‘‘(B) a review of out-of-pocket expendi-14
262	262	tures, including deductibles, copayments, coin-15
263	263	surance, monthly premiums, and estimated an-16
264	264	nual out-of-pocket costs, displayed overall and 17
265	265	by components, based on the best available in-18
266	266	formation as determined by the Secretary; and 19
267	267	‘‘(C) during the period prior to January 1, 20
268	268	2026, information regarding the rules that, in 21
269	269	each State, pertain to guaranteed issue of medi-22
270	270	care supplemental health insurance policies 23
271	271	prior to implementation of the provisions of the 24
272	272	Close the Medigap Act of 2025 and, in the case 25
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276	276	that a State has no such rules pertaining to 1
277	277	guaranteed issue of such policies, clear lan-2
278	278	guage explaining the implications of such lack 3
279	279	of rules for individuals with pre-existing condi-4
280	280	tions; 5
281	281	‘‘(2) not later than January 1, 2026, and peri-6
282	282	odically thereafter, perform a review of such website 7
283	283	in order to ensure that such website makes available 8
284	284	to individuals entitled to benefits under part A or 9
285	285	enrolled under part B the information that the Sec-10
286	286	retary determines is necessary for such individuals 11
287	287	to make informed choices regarding their options 12
288	288	under the program under this title; and 13
289	289	‘‘(3) not later than 12 months after the last 14
290	290	day of each period for the request for information 15
291	291	under subsection (e), update such website, taking 16
292	292	into consideration the information collected pursuant 17
293	293	to such subsection, to clarify the presentation of con-18
294	294	sumer options for medicare supplemental health in-19
295	295	surance policy options, including by presenting such 20
296	296	information in a manner calculated to be understood 21
297	297	by the average consumer and in a manner that— 22
298	298	‘‘(A) improves consumer access to informa-23
299	299	tion regarding the applicable premiums under 24
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303	303	such policy options as of the date on which such 1
304	304	website is so updated; 2
305	305	‘‘(B) facilitates consumers’ ability to com-3
306	306	pare and sort policy options and premium infor-4
307	307	mation across plan offerings in a given location; 5
308	308	‘‘(C) clarifies and explains differences in 6
309	309	policy value; 7
310	310	‘‘(D) rates and explains the financial sta-8
311	311	bility of issuers of such policies; 9
312	312	‘‘(E) provides data on the inflation rate of 10
313	313	different policies; 11
314	314	‘‘(F) provides information regarding the 12
315	315	guaranteed issue requirements that apply to 13
316	316	medicare supplemental health insurance policies 14
317	317	under section 1882(s)(3); and 15
318	318	‘‘(G) includes such general information as 16
319	319	is determined by the Secretary to be necessary 17
320	320	for individuals entitled to benefits under part A 18
321	321	or enrolled under part B to understand costs 19
322	322	under MA plans available pursuant to part C 20
323	323	and prescription drug plans available pursuant 21
324	324	to part D. 22
325	325	‘‘(e) Not later than 6 months after the date of the 23
326	326	enactment of this subsection and beginning on December 24
327	327	7 of each year thereafter, the Secretary of Health and 25
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331	331	Human Services shall provide an opportunity for public 1
332	332	comment during which the Secretary requests informa-2
333	333	tion, including recommendations, from stakeholders re-3
334	334	garding potential improvements to the presentation of 4
335	335	medicare supplemental health insurance policy options 5
336	336	under section 1882 on the Medicare plan finder internet 6
337	337	website of the Centers for Medicare & Medicaid Services 7
338	338	(or a successor website). 8
339	339	‘‘(f) With respect to any information that the Sec-9
340	340	retary makes available on the Medicare plan finder inter-10
341	341	net website of the Centers for Medicare & Medicaid Serv-11
342	342	ices (or a successor website) pursuant to subsection (d), 12
343	343	the Secretary shall, prior to making such information 13
344	344	available— 14
345	345	‘‘(1) provide, in consultation with the National 15
346	346	Association of Insurance Commissioners, an oppor-16
347	347	tunity for consumer testing of such information; 17
348	348	‘‘(2) share the results of such consumer testing 18
349	349	of such information with interested stakeholders; 19
350	350	and 20
351	351	‘‘(3) provide a 60-day public comment period 21
352	352	with respect to such information.’’. 22
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356	356	SEC. 6. RESTORING ACCESS TO FIRST-DOLLAR MEDIGAP 1
357	357	COVERAGE. 2
358	358	Section 1882 of the Social Security Act (42 U.S.C. 3
359	359	1395ss) is amended by striking subsection (z). 4
360	360	SEC. 7. BROKER TRANSPARENCY. 5
361	361	Section 1128G of the Social Security Act (42 U.S.C. 6
362	362	1320a–7h) is amended— 7
363	363	(1) in subsection (c)(1)(A), by striking ‘‘2011,’’ 8
364	364	and inserting ‘‘2011 (or, with respect to information 9
365	365	required to be submitted under subsection (f)(1), not 10
366	366	later than six months after the date of the enact-11
367	367	ment of such subsection),’’; and 12
368	368	(2) by adding at the end the following new sub-13
369	369	section: 14
370	370	‘‘(f) A
371	371	PPLICATION TOMEDIGAPINSURANCEBRO-15
372	372	KERS.— 16
373	373	‘‘(1) I
374	374	N GENERAL.—Beginning not later than 17
375	375	12 months after the date of enactment of this sub-18
376	376	section, each issuer of a medicare supplemental 19
377	377	health insurance policy shall annually submit to the 20
378	378	Secretary a report regarding payments or other 21
379	379	transfers of value made during the previous year to 22
380	380	agents, brokers, and other third parties representing 23
381	381	such policy. Each such report shall include the fol-24
382	382	lowing information, with respect to such a payment 25
383	383	or other transfer of value: 26
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387	387	‘‘(A) The name of the recipient of the pay-1
388	388	ment or other transfer of value. 2
389	389	‘‘(B) The business address of the recipient. 3
390	390	‘‘(C) The amount of the payment or other 4
391	391	transfer of value. 5
392	392	‘‘(D) The dates on which the payment or 6
393	393	transfer of value was provided. 7
394	394	‘‘(E) A description of the form of the pay-8
395	395	ment or transfer of value. 9
396	396	‘‘(F) Any other categories of information 10
397	397	the Secretary determines appropriate. 11
398	398	‘‘(2) A
399	399	PPLICATION OF TRANSPARENCY SYS -12
400	400	TEM.—The provisions of subsections (b) through (d) 13
401	401	shall apply to an issuer described in paragraph (1), 14
402	402	information required to be reported under such 15
403	403	paragraph, and agents, brokers, and other third par-16
404	404	ties described in such paragraph in the same manner 17
405	405	and to the same extent as such provisions apply to 18
406	406	an applicable manufacturer, information required to 19
407	407	be reported under subsection (a), and a covered re-20
408	408	cipient.’’. 21
409	409	Æ
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