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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5844 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5844

To amend title XVIII of the Social Security Act to provide all Medicare 
    beneficiaries with the right to guaranteed issue of a Medicare 
 supplemental policy and annual open change-in-enrollment periods, and 
                          for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             July 22, 2010

  Mr. Rothman of New Jersey 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 all Medicare 
    beneficiaries with the right to guaranteed issue of a Medicare 
 supplemental policy and annual open change-in-enrollment periods, and 
                          for other purposes.

    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 ``Fairness in Medigap Options Act of 
2010''.

SEC. 2. GUARANTEED ISSUE OF MEDIGAP POLICIES TO ALL MEDICARE 
              BENEFICIARIES.

    (a) In General.--Section 1882(s) of the Social Security Act (42 
U.S.C. 1395ss(s)) is amended--
            (1) 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'';
            (2) in paragraph (2)(D), by striking ``who is 65 years of 
        age or older as of the date of issuance and''; and
            (3) in paragraph (3)(B)(vi), by striking ``at age 65''.
    (b) Phase-In Authority.--
            (1) In general.--Subject to paragraph (2), the Secretary of 
        Health and Human Services may phase in the implementation of 
        the amendments made under subsection (a) in such manner as the 
        Secretary determines appropriate to minimize any adverse impact 
        on individuals enrolled under a Medicare supplemental policy 
        prior to the effective date of this Act.
            (2) Limit.--The phase-in period under paragraph (1) shall 
        not exceed 5 years.
    (c) Separate Premium Class.--
            (1) In general.--Subject to paragraph (2), any individuals 
        enrolled under a Medicare supplemental policy pursuant to the 
        amendments made under subsection (a) shall be classified by the 
        issuer as part of a separate premium class.
            (2) Limit.--The provision in paragraph (1) shall apply to 
        individuals that enroll under a Medicare supplemental policy 
        prior to January 1, 2015.
    (d) Additional Enrollment Period for Certain Individuals.--
            (1) One-time enrollment period.--
                    (A) In general.--In the case of an individual 
                described in paragraph (2), 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.
                    (B) Period.--The enrollment period established 
                under subparagraph (A) shall begin on the date on which 
                the phase-in period under subsection (b) is completed 
                and end 6 months after such date.
            (2) Individual described.--An individual described in this 
        paragraph is an individual who--
                    (A) is entitled to hospital insurance benefits 
                under part A of title XVIII of the Social Security Act 
                under section 226(b) or section 226A of such Act (42 
                U.S.C. 426(b); 426-1);
                    (B) is enrolled for benefits under part B of title 
                XVIII of such Act (42 U.S.C. 1395j et seq.); and
                    (C) would not, but for the provisions of and 
                amendments made by this section, be eligible for the 
                guaranteed issue of a Medicare supplemental policy 
                under section 1882(s)(2) of such Act (42 U.S.C. 
                1395ss(s)(2)).
            (3) Outreach plan.--The Secretary shall develop an outreach 
        plan to notify individuals described in paragraph (2) of the 
        one-time enrollment period established under paragraph (1).

SEC. 3. GUARANTEED ISSUE OF MEDIGAP POLICIES FOR MEDICARE ADVANTAGE AND 
              MEDICAID ENROLLEES.

    (a) In General.--Section 1882(s)(3) of the Social Security Act (42 
U.S.C. 1395ss(s)(3)), as amended by section 2, is amended--
            (1) 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;
                    ``(II) was eligible for medical assistance under a 
                State plan or waiver under title XIX and was enrolled 
                in such plan or waiver; and
                    ``(III) subsequently lost eligibility for such 
                medical assistance.'';
            (2) 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
            (3) in subparagraph (E)--
                    (A) in clause (iv), by striking ``and'' at the end;
                    (B) in clause (v), by striking the period at the 
                end and inserting a semicolon; and
                    (C) 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; and
            ``(vii) in the case of an individual described in 
        subparagraph (B)(viii), 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 
        123 days after the individual receives such notice.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to Medicare supplemental policies effective on or after January 
1, 2011.

SEC. 4. ENROLLMENT OF INDIVIDUALS WITH END STAGE RENAL DISEASE IN 
              MEDICARE ADVANTAGE.

    (a) In General.--Section 1851(a) of the Social Security Act (42 
U.S.C. 1395w-21(a)) is amended by striking paragraph (3) and inserting 
the following:
            ``(3) Medicare+choice eligible individual.--In this title, 
        the term `Medicare+Choice eligible individual' means an 
        individual who is entitled to benefits under part A and 
        enrolled under part B.''.
    (b) Conforming Amendments.--
            (1) Section 1852(b) of the Social Security Act (42 U.S.C. 
        1395w-22(b)) is amended by striking paragraph (1) and inserting 
        the following:
            ``(1) Beneficiaries.--A Medicare Advantage organization may 
        not deny, limit, or condition the coverage or provision of 
        benefits under this part, for individuals permitted to be 
        enrolled with the organization under this part, based on any 
        health status-related factor described in section 2705(a)(1) of 
        the Public Health Service Act (as amended by section 1201(4) of 
        the Patient Protection and Affordable Care Act). The Secretary 
        shall not approve a plan of an organization if the Secretary 
        determines that the design of the plan and its benefits are 
        likely to substantially discourage enrollment by certain MA 
        eligible individuals with the organization.''.
            (2) Section 1859(b)(6)(B) of such Act (42 U.S.C. 1395w-
        28(b)(6)(B)) is amended in the second sentence by striking 
        ``may waive application of section 1851(a)(3)(B) in the case of 
        an individual described in clause (i), (ii), or (iii) of this 
        subparagraph and''.
    (c) Effective Date.--The amendments made by this section shall 
apply to plan years beginning on or after January 1, 2011.

SEC. 5. PROVIDING FOR ANNUAL GUARANTEED-ISSUE CHANGES IN ENROLLMENT 
              UNDER MEDIGAP POLICIES.

    Section 1882(s) of the Social Security Act (42 U.S.C. 1395ss(s)) is 
amended--
            (1) by redesignating paragraph (4) as paragraph (5); and
            (2) by inserting after paragraph (3) the following new 
        paragraph:
    ``(4)(A) The Secretary shall specify an annual period (with the 
first such period occurring during 2011) during which individuals 
enrolled in a Medicare supplemental policy with a particular benefit 
package may change to another such policy if such other policy is 
offered by a different issuer and available for issuance to new 
enrollees by such issuer and if such other policy has the same benefit 
package or a benefit package with lesser benefits (as determined by the 
Secretary). Such annual period shall, to the extent feasible, coincide 
with annual open enrollment periods under parts C and D. A change in 
enrollment during such a period in a year shall become effective as of 
the first day of the following year.
    ``(B) In the case of an individual who seeks to change enrollment 
to a Medicare supplemental policy issued by a different issuer during 
an annual period pursuant to subparagraph (A), subject to subparagraph 
(C), the issuer of such policy--
            ``(i) may not deny or condition the issuance or 
        effectiveness of the policy a Medicare supplemental policy 
        described in subparagraph (A);
            ``(ii) may not discriminate in the pricing of such policy, 
        because of health status, claims experience, receipt of health 
        care, or medical condition; and
            ``(iii) may not impose an exclusion of benefits based on a 
        preexisting condition under such policy.
    ``(C) In the case of a change of enrollment under this paragraph 
and in order to prevent adverse selection under this paragraph from 
disrupting the orderly marketing of Medicare supplemental policies, the 
Secretary may permit the new issuer of the Medicare supplemental policy 
to apply such limited pre-existing conditions and such premium rating 
rules as may be appropriate.''.
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