I 

114TH CONGRESS 

2D SESSION H. R. 6265 

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 

SEPTEMBER 28, 2016 

Mr. MCDERMOTT (for himself, Mr. LEVIN, and Mr. CONYERS) 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medigap Consumer 

5 Protection Act of 2016’’. 

6 SEC. 2. GUARANTEED ISSUE. 

7 (a) GUARANTEED ISSUE OF MEDIGAP POLICIES TO

8 ALL MEDIGAP-ELIGIBLE MEDICARE BENEFICIARIES.— 


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1 (1) IN GENERAL.—Section 1882(s) of the So2 cial Security Act (42 U.S.C. 1395ss(s)) is amend3 ed— 

4 (A) in paragraph (2)(A), by striking ‘‘65 

5 years of age or older and is enrolled for benefits 

6 under part B’’ and inserting ‘‘entitled to, or en7 rolled for, benefits under part A and enrolled 

8 for benefits under part B’’; 

9 (B) in paragraph (2)(D), by striking ‘‘who 

10 is 65 years of age or older as of the date of 

11 issuance and’’; 

12 (C) in paragraph (3)(B)(ii), by striking ‘‘is 

13 65 years of age or older and’’; and 

14 (D) in paragraph (3)(B)(vi), by striking 

15 ‘‘at age 65’’. 

16 (2) EFFECTIVE DATE; PHASE-IN AUTHORITY.— 

17 (A) EFFECTIVE DATE.—Subject to sub18 paragraph (B), the amendments made by para19 graph (1) shall apply to medicare supplemental 

20 policies effective on or after January 1, 2020. 

21 (B) PHASE-IN AUTHORITY.— 

22 (i) IN GENERAL.—Subject to clause 

23 (ii), the Secretary of Health and Human 

24 Services may phase in the implementation 

25 of the amendments made under paragraph 


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1 (1) (with such phase-in beginning on or 

2 after January 1, 2020) in such manner as 

3 the Secretary determines appropriate in 

4 order to minimize any adverse impact on 

5 individuals enrolled under a medicare sup6 plemental policy. 

7 (ii) PHASE-IN PERIOD MAY NOT EX8 CEED 5 YEARS.—The Secretary of Health 

9 and Human Services shall ensure that the 

10 amendments made by paragraph (1) are 

11 fully implemented by not later than Janu12 ary 1, 2025. 

13 (3) ADDITIONAL ENROLLMENT PERIOD FOR

14 CERTAIN INDIVIDUALS.— 

15 (A) ONE-TIME ENROLLMENT PERIOD.— 

16 (i) IN GENERAL.—In the case of an 

17 individual described in subparagraph (B), 

18 the Secretary shall establish a one-time en19 rollment period during which such an indi20 vidual may enroll in any medicare supple21 mental policy of the individual’s choosing. 

22 (ii) PERIOD.—The enrollment period 

23 established under clause (i) shall begin on 

24 the date on which the phase-in period 


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1 under paragraph (2) is completed and end 

2 6 months after such date. 

3 (B) INDIVIDUAL DESCRIBED.—An indi4 vidual described in this paragraph is an indi5 vidual who— 

6 (i) is entitled to hospital insurance 

7 benefits under part A under section 226(b) 

8 or section 226A of the Social Security Act 

9 (42 U.S.C. 426(b); 426–1); 

10 (ii) is enrolled for benefits under part 

11 B of such Act (42 U.S.C. 1395j et seq.); 

12 and 

13 (iii) would not, but for the provisions 

14 of and amendments made by paragraphs 

15 (1) and (2), be eligible for the guaranteed 

16 issue of a medicare supplemental policy 

17 under paragraph (2) or (3) of section 

18 1882(s) of such Act (42 U.S.C. 1395ss(s)). 

19 (C) OUTREACH PLAN.— 

20 (i) IN GENERAL.—The Secretary shall 

21 develop an outreach plan to notify individ22 uals described in subparagraph (B) of the 

23 one-time enrollment period established 

24 under subparagraph (A). 


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1 (ii) CONSULTATION.—In imple2 menting the outreach plan developed under 

3 clause (i), the Secretary shall consult with 

4 consumer advocates, brokers, insurers, the 

5 National Association of Insurance Commis6 sioners, and State Health Insurance As7 sistance Programs. 

8 (b) GUARANTEED ISSUE OF MEDIGAP POLICIES FOR

9 MEDICARE ADVANTAGE AND MEDICAID ENROLLEES; 

10 TREATMENT OF INDIVIDUALS WITH COBRA.— 

11 (1) IN GENERAL.—Section 1882(s)(3) of the 

12 Social Security Act (42 U.S.C. 1395ss(s)(3)), as 

13 amended by subsection (a), is further amended— 

14 (A) in subparagraph (B), by adding at the 

15 end the following new clauses: 

16 ‘‘(vii) The individual was enrolled in a Medicare 

17 Advantage plan under part C for not less than 12 

18 months and subsequently disenrolled from such plan 

19 and elects to receive benefits under this title through 

20 the original Medicare fee-for-service program under 

21 parts A and B. 

22 ‘‘(viii) The individual— 

23 ‘‘(I) is entitled to, or enrolled for, benefits 

24 under part A and enrolled for benefits under 

25 part B; and 


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1 ‘‘(II) either— 

2 ‘‘(aa) is eligible for medical assistance 

3 under a State plan or waiver under title 

4 XIX based on a reduction of income of the 

5 individual based on costs incurred for med6 ical or other remedial care and was en7 rolled in such plan or waiver; or 

8 ‘‘(bb) was otherwise eligible for med9 ical assistance under a State plan or waiv10 er under title XIX and subsequently lost 

11 eligibility for such medical assistance.’’; 

12 (B) by striking subparagraph (C)(iii) and 

13 inserting the following: 

14 ‘‘(iii) Subject to subsection (v)(1), for purposes 

15 of an individual described in clause (vi), (vii), or 

16 (viii) of subparagraph (B), a medicare supplemental 

17 policy described in this subparagraph shall include 

18 any medicare supplemental policy.’’; and 

19 (C) in subparagraph (E)— 

20 (i) in clause (iv), by striking ‘‘and’’ at 

21 the end; 

22 (ii) in clause (v), by striking the pe23 riod at the end and inserting a semicolon; 

24 and 


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1 (iii) by adding at the end the fol2 lowing new clauses— 

3 ‘‘(vi) in the case of an individual described in 

4 subparagraph (B)(vii), the annual, coordinated elec5 tion period (as defined in section 1851(e)(3)(B)) or 

6 a continuous open enrollment period (as defined in 

7 section 1851(e)(2)) during which the individual 

8 disenrolls from a Medicare Advantage plan under 

9 part C; 

10 ‘‘(vii) in the case of an individual described in 

11 subparagraph (B)(viii) who is eligible for medical as12 sistance under a State plan or waiver under title 

13 XIX for a reason described in item (aa), such period 

14 as is specified by the Secretary; 

15 ‘‘(viii) in the case of an individual described in 

16 subparagraph (B)(viii) who is eligible for medical as17 sistance under a State plan or waiver under title 

18 XIX for a reason described in item (bb), the period 

19 beginning on the date that the individual receives a 

20 notice of cessation of such individual’s eligibility for 

21 medical assistance under the State plan or waiver 

22 under title XIX and ending on the date that is four 

23 months after the individual receives such notice; 

24 and’’. 


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1 (2) TREATMENT OF INDIVIDUALS WITH

2 COBRA.— 

3 (A) IN GENERAL.—Section 1882(s)(3) of 

4 the Social Security Act (42 U.S.C. 

5 1395ss(s)(3)), as amended by subsection (a) 

6 and paragraph (1), is further amended— 

7 (i) in subparagraph (B)(i) by insert8 ing ‘‘or, in the case of an individual en9 rolled in such an employee welfare benefit 

10 plan pursuant to a COBRA continuation 

11 provision (as defined in section 2791(d)(4) 

12 of the Public Health Service Act), that the 

13 individual disenrolls from such plan and 

14 enrolls under part B’’ before the period at 

15 the end; and 

16 (ii) in subparagraph (E), as amended 

17 by paragraph (1), by adding at the end the 

18 following new clause: 

19 ‘‘(viii) in the case of an individual described in 

20 subparagraph (B)(i) who enrolled in an employee 

21 welfare benefit plan described in such subparagraph 

22 pursuant to a COBRA continuation provision (as de23 fined in section 2791(d)(4) of the Public Health 

24 Service Act) and who disenrolls from such plan and 

25 enrolls under part B, the period beginning on 60 


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1 days before the effective date of such disenrollment 

2 and ending on the date that is 63 days after such 

3 effective date.’’. 

4 (B) TECHNICAL CORRECTION.—Section 

5 1882(s)(2)(D) of the Social Security Act (42 

6 U.S.C. 1395ss(s)(2)(D)) is amended— 

7 (i) by striking ‘‘2701(c)’’ and insert8 ing ‘‘2704(c)’’; and 

9 (ii) by striking ‘‘2701(a)(3)’’ and in10 serting ‘‘2704(a)(3)’’. 

11 (3) EFFECTIVE DATE.—The amendments made 

12 by paragraphs (1) and (2)(A) shall apply to medi13 care supplemental policies effective on or after Janu14 ary 1, 2020. 

15 SEC. 3. MEDICAL LOSS RATIO. 

16 Section 1882(r)(1)(A) of the Social Security Act (42 

17 U.S.C. 1395ss(r)(1)(A)) is amended— 

18 (1) by inserting ‘‘and periodically reviewed’’ 

19 after ‘‘developed’’; 

20 (2) by striking ‘‘policy, at least 75 percent of 

21 the aggregate amount of premiums collected in the 

22 case of group policies and at least 65 percent in the 

23 case of individual policies; and’’ and inserting the 

24 following: ‘‘policy— 


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1 ‘‘(i) with respect to periods beginning be2 fore January 1, 2020, at least 75 percent of the 

3 aggregate amount of premiums collected in the 

4 case of group policies and at least 65 percent 

5 in the case of individual policies; and 

6 ‘‘(ii) with respect to periods beginning on 

7 or after January 1, 2020, a percent of the ag8 gregate amount of premiums collected that, in 

9 the case of group policies or individual policies, 

10 as applicable, is equal to or greater than both— 

11 ‘‘(I) the applicable percent specified in 

12 clause (i) with respect to such policies; and 

13 ‘‘(II) such percent as the National As14 sociation of Insurance Commissioners may 

15 recommend to the Secretary with respect 

16 to such policies for purposes of this para17 graph; and’’. 

18 SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION. 

19 (a) IN GENERAL.—Section 1882 of the Social Secu20 rity Act (42 U.S.C. 1395ss), as amended by section 6, is 

21 further amended by adding at the end the following new 

22 subsection: 

23 ‘‘(aa) DEVELOPMENT OF NEW STANDARDS RELAT24 ING TO PRICING DISCRIMINATION.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall request 

2 the National Association of Insurance Commis3 sioners to review and revise the standards for all 

4 benefit packages under subsection (p)(1), including 

5 the core benefit package, in order to provide cov6 erage consistent with paragraph (2). Such revisions 

7 shall be made consistent with the rules applicable 

8 under subsection (p)(1)(E) (with the reference to the 

9 ‘1991 NAIC Model Regulation’ deemed a reference 

10 to the NAIC Model Regulation as most recently up11 dated by the National Association of Insurance 

12 Commissioners to reflect previous changes in law 

13 and the reference to ‘date of enactment of this sub14 section’ deemed a reference to the date of enactment 

15 of this subsection). 

16 ‘‘(2) CHANGES IN COST-SHARING DESCRIBED.— 

17 Under the revised standards, coverage shall not be 

18 available under a Medicare supplemental insurance 

19 policy unless the issuer of the policy, in addition to 

20 conforming to the other applicable requirements of 

21 this section— 

22 ‘‘(A) does not discriminate in the pricing 

23 of the policy because of the age of the indi24 vidual to whom the policy is issued; 


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1 ‘‘(B) does not, to an extent that jeopard2 izes the access to such policy for individuals 

3 who are eligible to participate in the program 

4 under this title because the individuals are indi5 viduals described in paragraph (2) or (3) of sec6 tion 1811, discriminate in the pricing of the 

7 policy because the individual to whom the policy 

8 is issued is so eligible to participate in such 

9 program because the individual is an individual 

10 so described in such a paragraph; and 

11 ‘‘(C) does not establish premiums applica12 ble under such policy on a basis that would 

13 apply to a portion of, but not the entirety of, 

14 a county or equivalent area specified by the 

15 Secretary. 

16 ‘‘(3) APPLICATION DATE.—The revised stand17 ards shall apply to benefit packages sold, issued, or 

18 renewed under this section to individuals who first 

19 become entitled to benefits under part A or first en20 rolls in part B on or after January 1, 2020.’’. 

21 (b) CONFORMING AMENDMENT.—Section 1882(o)(1) 

22 of such Act (42 U.S.C. 1395ss(o)(1)) is amended by strik23 ing ‘‘, and (y)’’ and inserting ‘‘(y), and (aa)’’. 


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1 SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDI2 CARE PLAN FINDER WEBSITE. 

3 Section 1804 of the Social Security Act (42 U.S.C. 

4 1395b–2) is amended by adding at the end the following 

5 new subsections: 

6 ‘‘(d) In the case that the Secretary provides for a 

7 Medicare plan finder Internet website of the Centers for 

8 Medicare & Medicaid Services (or a successor website), the 

9 Secretary shall, with respect to such website and in ac10 cordance with subsection (f)— 

11 ‘‘(1) make available on such website— 

12 ‘‘(A) access to provider networks in order 

13 to provide to individuals entitled to benefits 

14 under part A or enrolled under part B informa15 tion to assist such individuals in understanding 

16 the restrictions on providers and potential costs 

17 entailed by their decisions regarding enrollment 

18 under parts A and B, under part C, and in 

19 medicare supplemental policies under section 

20 1882; 

21 ‘‘(B) a review of out-of-pocket expendi22 tures, including deductibles, copayments, coin23 surance, monthly premiums, and estimated an24 nual out-of-pocket costs, displayed overall and 

25 by components, based on the best available in26 formation as determined by the Secretary; and 


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1 ‘‘(C) during the period prior to January 1, 

2 2023, information regarding the rules that, in 

3 each State, pertain to guaranteed issue of medi4 care supplemental health insurance policies 

5 prior to implementation of the provisions of the 

6 Medigap Consumer Protection Act of 2016 and, 

7 in the case that a State has no such rules per8 taining to guaranteed issue of such policies, 

9 clear language explaining the implications of 

10 such lack of rules for individuals with pre-exist11 ing conditions; 

12 ‘‘(2) not later than January 1, 2018, and peri13 odically thereafter, perform a review of such website 

14 in order to ensure that such website makes available 

15 to individuals entitled to benefits under part A or 

16 enrolled under part B the information that the Sec17 retary determines is necessary for such individuals 

18 to make informed choices regarding their options 

19 under the program under this title; and 

20 ‘‘(3) not later than 12 months after the last 

21 day of each period for the request for information 

22 under subsection (e), update such website, taking 

23 into consideration the information collected pursuant 

24 to such subsection, to clarify the presentation of con25 sumer options for medicare supplemental health inVerDate Sep 11 2014 00:01 Oct 06, 2016 Jkt 069200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H6265.IH H6265

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1 surance policy options, including by presenting such 

2 information in a manner calculated to be understood 

3 by the average consumer and in a manner that— 

4 ‘‘(A) improves consumer access to informa5 tion regarding the applicable premiums under 

6 such policy options as of the date on which such 

7 website is so updated; 

8 ‘‘(B) facilitates consumers’ ability to com9 pare and sort policy options and premium infor10 mation across plan offerings in a given location; 

11 ‘‘(C) clarifies and explains differences in 

12 policy value; 

13 ‘‘(D) rates and explains the financial sta14 bility of issuers of such policies; 

15 ‘‘(E) provides data on the inflation rate of 

16 different policies; 

17 ‘‘(F) provides information regarding the 

18 guaranteed issue requirements that apply to 

19 medicare supplemental health insurance policies 

20 under section 1882(s)(3); and 

21 ‘‘(G) includes such general information as 

22 is determined by the Secretary to be necessary 

23 for individuals entitled to benefits under part A 

24 or enrolled under part B to understand costs 

25 under MA plans available pursuant to part C 


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1 and prescription drug plans available pursuant 

2 to part D. 

3 ‘‘(e) Not later than 6 months after the date of the 

4 enactment of this subsection and beginning on December 

5 7 of each year thereafter, the Secretary of Health and 

6 Human Services shall provide an opportunity for public 

7 comment during which the Secretary requests informa8 tion, including recommendations, from stakeholders re9 garding potential improvements to the presentation of 

10 medicare supplemental health insurance policy options 

11 under section 1882 on the Medicare plan finder Internet 

12 website of the Centers for Medicare & Medicaid Services 

13 (or a successor website). 

14 ‘‘(f) With respect to any information that the Sec15 retary makes available on the Medicare plan finder Inter16 net website of the Centers for Medicare & Medicaid Serv17 ices (or a successor website) pursuant to subsection (d), 

18 the Secretary shall, prior to making such information 

19 available— 

20 ‘‘(1) provide, in consultation with the National 

21 Association of Insurance Commissioners, an oppor22 tunity for consumer testing of such information; 

23 ‘‘(2) share the results of such consumer testing 

24 of such information with interested stakeholders; 

25 and 


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1 ‘‘(3) provide a 60-day public comment period 

2 with respect to such information.’’. 

3 SEC. 6. RESTORING ACCESS TO FIRST-DOLLAR MEDIGAP 

4 COVERAGE. 

5 Section 1882 of the Social Security Act (42 U.S.C. 

6 1395ss) is amended by striking subsection (z). 

7 SEC. 7. BROKER CONFLICTS OF INTEREST. 

8 Section 1128G of the Social Security Act (42 U.S.C. 

9 1320a–7h) is amended— 

10 (1) in subsection (c)(1)(A), by striking ‘‘2011,’’ 

11 and inserting ‘‘2011 (or, with respect to information 

12 required to be submitted under subsection (f)(1), not 

13 later than six months after the date of the enact14 ment of such subsection),’’; and 

15 (2) by adding at the end the following new sub16 section: 

17 ‘‘(f) APPLICATION TO MEDIGAP INSURANCE BRO18 KERS.— 

19 ‘‘(1) IN GENERAL.—Beginning not later than 

20 12 months after the date of enactment of this sub21 section, each issuer of a medicare supplemental 

22 health insurance policy shall annually submit to the 

23 Secretary a report regarding payments or other 

24 transfers of value made during the previous year to 

25 agents, brokers, and other third parties representing 


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1 such policy. Each such report shall include the fol2 lowing information, with respect to such a payment 

3 or other transfer of value: 

4 ‘‘(A) The name of the recipient of the pay5 ment or other transfer of value. 

6 ‘‘(B) The business address of the recipient. 

7 ‘‘(C) The amount of the payment or other 

8 transfer of value. 

9 ‘‘(D) The dates on which the payment or 

10 transfer of value was provided. 

11 ‘‘(E) A description of the form of the pay12 ment or transfer of value. 

13 ‘‘(F) Any other categories of information 

14 the Secretary determines appropriate. 

15 ‘‘(2) APPLICATION OF TRANSPARENCY SYS16 TEM.—The provisions of subsections (b) through (d) 

17 shall apply to an issuer described in paragraph (1), 

18 information required to be reported under such 

19 paragraph, and agents, brokers, and other third par20 ties described in such paragraph in the same manner 

21 and to the same extent as such provisions apply to 

22 an applicable manufacturer, information required to 

23 be reported under subsection (a), and a covered re24 cipient.’’. 

Æ 


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