Medigap Consumer Protection Act of 2018
This bill (1) expands guaranteed issue rights with respect to Medigap policies (Medicare supplemental health insurance policies), (2) eliminates certain limitations on Medigap policies for newly eligible Medicare beneficiaries, and (3) modifies other provisions related to Medigap policies. ("Guaranteed issue" rights require that a policy be offered to any eligible applicant without regard to health status.)
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6431 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 6431
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
July 18, 2018
Mr. Levin (for himself, Mr. Neal, Mr. Blumenauer, Mr. Higgins of New
York, Ms. Judy Chu of California, Mr. Danny K. Davis of Illinois, and
Mr. Lewis of Georgia) 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 committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for certain
reforms with respect to medicare supplemental health insurance
policies.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medigap Consumer Protection Act of
2018''.
SEC. 2. GUARANTEED ISSUE.
(a) Guaranteed Issue of Medigap Policies to All Medigap-Eligible
Medicare Beneficiaries.--
(1) In general.--Section 1882(s) of the Social Security Act
(42 U.S.C. 1395ss(s)) is amended--
(A) in paragraph (2)(A), by striking ``65 years of
age or older and is enrolled for benefits under part
B'' and inserting ``entitled to, or enrolled for,
benefits under part A and enrolled for benefits under
part B'';
(B) in paragraph (2)(D), by striking ``who is 65
years of age or older as of the date of issuance and'';
(C) in paragraph (3)(B)(ii), by striking ``is 65
years of age or older and''; and
(D) in paragraph (3)(B)(vi), by striking ``at age
65''.
(2) Effective date; phase-in authority.--
(A) Effective date.--Subject to subparagraph (B),
the amendments made by paragraph (1) shall apply to
medicare supplemental policies effective on or after
January 1, 2022.
(B) Phase-in authority.--
(i) In general.--Subject to clause (ii),
the Secretary of Health and Human Services may
phase in the implementation of the amendments
made under paragraph (1) (with such phase-in
beginning on or after January 1, 2022) in such
manner as the Secretary determines appropriate
in order to minimize any adverse impact on
individuals enrolled under a medicare
supplemental policy.
(ii) Phase-in period may not exceed 5
years.--The Secretary of Health and Human
Services shall ensure that the amendments made
by paragraph (1) are fully implemented by not
later than January 1, 2027.
(3) Additional enrollment period for certain individuals.--
(A) One-time enrollment period.--
(i) In general.--In the case of an
individual described in subparagraph (B), the
Secretary shall establish a one-time enrollment
period during which such an individual may
enroll in any medicare supplemental policy of
the individual's choosing.
(ii) Period.--The enrollment period
established under clause (i) shall begin on the
date on which the phase-in period under
paragraph (2) is completed and end 6 months
after such date.
(B) Individual described.--An individual described
in this paragraph is an individual who--
(i) is entitled to hospital insurance
benefits under part A under section 226(b) or
section 226A of the Social Security Act (42
U.S.C. 426(b); 426-1);
(ii) is enrolled for benefits under part B
of such Act (42 U.S.C. 1395j et seq.); and
(iii) would not, but for the provisions of
and amendments made by paragraphs (1) and (2),
be eligible for the guaranteed issue of a
medicare supplemental policy under paragraph
(2) or (3) of section 1882(s) of such Act (42
U.S.C. 1395ss(s)).
(C) Outreach plan.--
(i) In general.--The Secretary shall
develop an outreach plan to notify individuals
described in subparagraph (B) of the one-time
enrollment period established under
subparagraph (A).
(ii) Consultation.--In implementing the
outreach plan developed under clause (i), the
Secretary shall consult with consumer
advocates, brokers, insurers, the National
Association of Insurance Commissioners, and
State Health Insurance Assistance Programs.
(b) Guaranteed Issue of Medigap Policies for Medicare Advantage and
Medicaid Enrollees; Treatment of Individuals With COBRA.--
(1) In general.--Section 1882(s)(3) of the Social Security
Act (42 U.S.C. 1395ss(s)(3)), as amended by subsection (a), is
further amended--
(A) in subparagraph (B), by adding at the end the
following new clauses:
``(vii) The individual was enrolled in a Medicare Advantage
plan under part C for not less than 12 months and subsequently
disenrolled from such plan and elects to receive benefits under
this title through the original Medicare fee-for-service
program under parts A and B.
``(viii) The individual--
``(I) is entitled to, or enrolled for, benefits
under part A and enrolled for benefits under part B;
and
``(II) either--
``(aa) is eligible for medical assistance
under a State plan or waiver under title XIX
based on a reduction of income of the
individual based on costs incurred for medical
or other remedial care and was enrolled in such
plan or waiver; or
``(bb) was otherwise eligible for medical
assistance under a State plan or waiver under
title XIX and subsequently lost eligibility for
such medical assistance.'';
(B) by striking subparagraph (C)(iii) and inserting
the following:
``(iii) Subject to subsection (v)(1), for purposes of an
individual described in clause (vi), (vii), or (viii) of
subparagraph (B), a medicare supplemental policy described in
this subparagraph shall include any medicare supplemental
policy.''; and
(C) in subparagraph (E)--
(i) in clause (iv), by striking ``and'' at
the end;
(ii) in clause (v), by striking the period
at the end and inserting a semicolon; and
(iii) by adding at the end the following
new clauses--
``(vi) in the case of an individual described in
subparagraph (B)(vii), the annual, coordinated election period
(as defined in section 1851(e)(3)(B)) or a continuous open
enrollment period (as defined in section 1851(e)(2)) during
which the individual disenrolls from a Medicare Advantage plan
under part C;
``(vii) in the case of an individual described in
subparagraph (B)(viii) who is eligible for medical assistance
under a State plan or waiver under title XIX for a reason
described in item (aa), such period as is specified by the
Secretary;
``(viii) in the case of an individual described in
subparagraph (B)(viii) who is eligible for medical assistance
under a State plan or waiver under title XIX for a reason
described in item (bb), the period beginning on the date that
the individual receives a notice of cessation of such
individual's eligibility for medical assistance under the State
plan or waiver under title XIX and ending on the date that is
four months after the individual receives such notice; and''.
(2) Treatment of individuals with cobra.--
(A) In general.--Section 1882(s)(3) of the Social
Security Act (42 U.S.C. 1395ss(s)(3)), as amended by
subsection (a) and paragraph (1), is further amended--
(i) in subparagraph (B)(i) by inserting
``or, in the case of an individual enrolled in
such an employee welfare benefit plan pursuant
to a COBRA continuation provision (as defined
in section 2791(d)(4) of the Public Health
Service Act), that the individual disenrolls
from such plan and enrolls under part B''
before the period at the end; and
(ii) in subparagraph (E), as amended by
paragraph (1), by adding at the end the
following new clause:
``(ix) in the case of an individual described in
subparagraph (B)(i) who enrolled in an employee welfare benefit
plan described in such subparagraph pursuant to a COBRA
continuation provision (as defined in section 2791(d)(4) of the
Public Health Service Act) and who disenrolls from such plan
and enrolls under part B, the period beginning on 60 days
before the effective date of such disenrollment and ending on
the date that is 63 days after such effective date.''.
(B) Technical correction.--Section 1882(s)(2)(D) of
the Social Security Act (42 U.S.C. 1395ss(s)(2)(D)) is
amended--
(i) by striking ``2701(c)'' and inserting
``2704(c)''; and
(ii) by striking ``2701(a)(3)'' and
inserting ``2704(a)(3)''.
(3) Effective date.--The amendments made by paragraphs (1)
and (2)(A) shall apply to medicare supplemental policies
effective on or after January 1, 2022.
SEC. 3. MEDICAL LOSS RATIO.
Section 1882(r)(1)(A) of the Social Security Act (42 U.S.C.
1395ss(r)(1)(A)) is amended--
(1) by inserting ``and periodically reviewed'' after
``developed''; and
(2) by striking ``policy, at least 75 percent of the
aggregate amount of premiums collected in the case of group
policies and at least 65 percent in the case of individual
policies; and'' and inserting the following: ``policy--
``(i) with respect to periods beginning before
January 1, 2022, at least 75 percent of the aggregate
amount of premiums collected in the case of group
policies and at least 65 percent in the case of
individual policies; and
``(ii) with respect to periods beginning on or
after January 1, 2022, a percent of the aggregate
amount of premiums collected that, in the case of group
policies or individual policies, as applicable, is
equal to or greater than both--
``(I) the applicable percent specified in
clause (i) with respect to such policies; and
``(II) such percent as the National
Association of Insurance Commissioners may
recommend to the Secretary with respect to such
policies for purposes of this paragraph; and''.
SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION.
(a) In General.--Section 1882 of the Social Security Act (42 U.S.C.
1395ss), as amended by section 6, is further amended by adding at the
end the following new subsection:
``(aa) Development of New Standards Relating to Pricing
Discrimination.--
``(1) In general.--The Secretary shall request the National
Association of Insurance Commissioners to review and revise the
standards for all benefit packages under subsection (p)(1),
including the core benefit package, in order to provide
coverage consistent with paragraph (2). Such revisions shall be
made consistent with the rules applicable under subsection
(p)(1)(E) (with the reference to the `1991 NAIC Model
Regulation' deemed a reference to the NAIC Model Regulation as
most recently updated by the National Association of Insurance
Commissioners to reflect previous changes in law and the
reference to `date of enactment of this subsection' deemed a
reference to the date of enactment of this subsection).
``(2) Changes in cost-sharing described.--Under the revised
standards, coverage shall not be available under a Medicare
supplemental insurance policy unless the issuer of the policy,
in addition to conforming to the other applicable requirements
of this section--
``(A) does not discriminate in the pricing of the
policy because of the age of the individual to whom the
policy is issued;
``(B) does not, to an extent that jeopardizes the
access to such policy for individuals who are eligible
to participate in the program under this title because
the individuals are individuals described in paragraph
(2) or (3) of section 1811, discriminate in the pricing
of the policy because the individual to whom the policy
is issued is so eligible to participate in such program
because the individual is an individual so described in
such a paragraph; and
``(C) does not establish premiums applicable under
such policy on a basis that would apply to a portion
of, but not the entirety of, a county or equivalent
area specified by the Secretary.
``(3) Application date.--The revised standards shall apply
to benefit packages sold, issued, or renewed under this section
to individuals who first become entitled to benefits under part
A or first enrolls in part B on or after January 1, 2022.''.
(b) Conforming Amendment.--Section 1882(o)(1) of such Act (42
U.S.C. 1395ss(o)(1)) is amended by striking ``, and (y)'' and inserting
``(y), and (aa)''.
SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDICARE PLAN FINDER
WEBSITE.
Section 1804 of the Social Security Act (42 U.S.C. 1395b-2) is
amended by adding at the end the following new subsections:
``(d) In the case that the Secretary provides for a Medicare plan
finder Internet website of the Centers for Medicare & Medicaid Services
(or a successor website), the Secretary shall, with respect to such
website and in accordance with subsection (f)--
``(1) make available on such website--
``(A) access to provider networks in order to
provide to individuals entitled to benefits under part
A or enrolled under part B information to assist such
individuals in understanding the restrictions on
providers and potential costs entailed by their
decisions regarding enrollment under parts A and B,
under part C, and in medicare supplemental policies
under section 1882;
``(B) a review of out-of-pocket expenditures,
including deductibles, copayments, coinsurance, monthly
premiums, and estimated annual out-of-pocket costs,
displayed overall and by components, based on the best
available information as determined by the Secretary;
and
``(C) during the period prior to January 1, 2025,
information regarding the rules that, in each State,
pertain to guaranteed issue of medicare supplemental
health insurance policies prior to implementation of
the provisions of the Medigap Consumer Protection Act
of 2018 and, in the case that a State has no such rules
pertaining to guaranteed issue of such policies, clear
language explaining the implications of such lack of
rules for individuals with pre-existing conditions;
``(2) not later than January 1, 2020, and periodically
thereafter, perform a review of such website in order to ensure
that such website makes available to individuals entitled to
benefits under part A or enrolled under part B the information
that the Secretary determines is necessary for such individuals
to make informed choices regarding their options under the
program under this title; and
``(3) not later than 12 months after the last day of each
period for the request for information under subsection (e),
update such website, taking into consideration the information
collected pursuant to such subsection, to clarify the
presentation of consumer options for medicare supplemental
health insurance policy options, including by presenting such
information in a manner calculated to be understood by the
average consumer and in a manner that--
``(A) improves consumer access to information
regarding the applicable premiums under such policy
options as of the date on which such website is so
updated;
``(B) facilitates consumers' ability to compare and
sort policy options and premium information across plan
offerings in a given location;
``(C) clarifies and explains differences in policy
value;
``(D) rates and explains the financial stability of
issuers of such policies;
``(E) provides data on the inflation rate of
different policies;
``(F) provides information regarding the guaranteed
issue requirements that apply to medicare supplemental
health insurance policies under section 1882(s)(3); and
``(G) includes such general information as is
determined by the Secretary to be necessary for
individuals entitled to benefits under part A or
enrolled under part B to understand costs under MA
plans available pursuant to part C and prescription
drug plans available pursuant to part D.
``(e) Not later than 6 months after the date of the enactment of
this subsection and beginning on December 7 of each year thereafter,
the Secretary of Health and Human Services shall provide an opportunity
for public comment during which the Secretary requests information,
including recommendations, from stakeholders regarding potential
improvements to the presentation of medicare supplemental health
insurance policy options under section 1882 on the Medicare plan finder
Internet website of the Centers for Medicare & Medicaid Services (or a
successor website).
``(f) With respect to any information that the Secretary makes
available on the Medicare plan finder Internet website of the Centers
for Medicare & Medicaid Services (or a successor website) pursuant to
subsection (d), the Secretary shall, prior to making such information
available--
``(1) provide, in consultation with the National
Association of Insurance Commissioners, an opportunity for
consumer testing of such information;
``(2) share the results of such consumer testing of such
information with interested stakeholders; and
``(3) provide a 60-day public comment period with respect
to such information.''.
SEC. 6. RESTORING ACCESS TO FIRST-DOLLAR MEDIGAP COVERAGE.
Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is
amended by striking subsection (z).
SEC. 7. BROKER TRANSPARENCY.
Section 1128G of the Social Security Act (42 U.S.C. 1320a-7h) is
amended--
(1) in subsection (c)(1)(A), by striking ``2011,'' and
inserting ``2011 (or, with respect to information required to
be submitted under subsection (f)(1), not later than six months
after the date of the enactment of such subsection),''; and
(2) by adding at the end the following new subsection:
``(f) Application to Medigap Insurance Brokers.--
``(1) In general.--Beginning not later than 12 months after
the date of enactment of this subsection, each issuer of a
medicare supplemental health insurance policy shall annually
submit to the Secretary a report regarding payments or other
transfers of value made during the previous year to agents,
brokers, and other third parties representing such policy. Each
such report shall include the following information, with
respect to such a payment or other transfer of value:
``(A) The name of the recipient of the payment or
other transfer of value.
``(B) The business address of the recipient.
``(C) The amount of the payment or other transfer
of value.
``(D) The dates on which the payment or transfer of
value was provided.
``(E) A description of the form of the payment or
transfer of value.
``(F) Any other categories of information the
Secretary determines appropriate.
``(2) Application of transparency system.--The provisions
of subsections (b) through (d) shall apply to an issuer
described in paragraph (1), information required to be reported
under such paragraph, and agents, brokers, and other third
parties described in such paragraph in the same manner and to
the same extent as such provisions apply to an applicable
manufacturer, information required to be reported under
subsection (a), and a covered recipient.''.
<all>
Introduced in House
Introduced in House
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 committee concerned.
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 committee concerned.
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