II 

116TH CONGRESS 

1ST SESSION S. 2428 

To amend title XVIII of the Social Security Act to provide for certain 

reforms with respect to Medicare supplemental health insurance policies, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 1, 2019 

Mr. BROWN (for himself and Ms. KLOBUCHAR) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for certain reforms with respect to Medicare supplemental health insurance policies, and for other purposes. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medigap Consumer Protection Act of 2019’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Guaranteed issue. 

Sec. 3. Limitations on pricing discrimination. 

Sec. 4. Clarification regarding standardized Medigap plans. 


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Sec. 5. Improving information available to Medicare beneficiaries. 

Sec. 6. Broker conflicts of interest. 

Sec. 7. Protecting against high out-of-pocket expenditures for Medicare fee-forservice benefits. 

Sec. 8. Study and report on variations among Medigap plans. 

1 SEC. 2. GUARANTEED ISSUE. 

2 (a) GUARANTEED ISSUE OF MEDIGAP POLICIES TO

3 ALL MEDIGAP-ELIGIBLE MEDICARE BENEFICIARIES.— 

4 (1) IN GENERAL.—Section 1882(s) of the So5 cial Security Act (42 U.S.C. 1395ss(s)) is amend6 ed— 

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

8 years of age or older and is enrolled for benefits 

9 under part B’’ and inserting ‘‘entitled to, or en10 rolled for, benefits under part A and enrolled 

11 for benefits under part B’’; 

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

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

14 issuance and’’; 

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

16 65 years of age or older and’’; and 

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

18 ‘‘at age 65’’. 

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

20 (A) EFFECTIVE DATE.—Subject to sub21 paragraph (B), the amendments made by para22 graph (1) shall apply to Medicare supplemental 

23 policies effective on or after January 1, 2023. 


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1 (B) PHASE-IN AUTHORITY.— 

2 (i) IN GENERAL.—Subject to clause 

3 (ii), the Secretary of Health and Human 

4 Services may phase-in the implementation 

5 of the amendments made under paragraph 

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

7 after January 1, 2023) in such manner as 

8 the Secretary determines appropriate in 

9 order to minimize any adverse impact on 

10 individuals enrolled under a Medicare sup11 plemental policy. 

12 (ii) PHASE-IN PERIOD MAY NOT EX13 CEED 5 YEARS.—The Secretary of Health 

14 and Human Services shall ensure that the 

15 amendments made by paragraph (1) are 

16 fully implemented by not later than Janu17 ary 1, 2028. 

18 (3) ADDITIONAL ENROLLMENT PERIOD FOR

19 CERTAIN INDIVIDUALS.— 

20 (A) ONE-TIME ENROLLMENT PERIOD.— 

21 (i) IN GENERAL.—In the case of an 

22 individual described in subparagraph (B), 

23 the Secretary of Health and Human Serv24 ices shall establish a one-time enrollment 

25 period during which such an individual 


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1 may enroll in any Medicare supplemental 

2 policy of the individual’s choosing. 

3 (ii) PERIOD.—The enrollment period 

4 established under clause (i) shall begin on 

5 the date on which the phase-in period 

6 under paragraph (2) is completed and end 

7 6 months after such date. 

8 (B) INDIVIDUAL DESCRIBED.—An indi9 vidual described in this paragraph is an indi10 vidual who— 

11 (i) is entitled to hospital insurance 

12 benefits under part A under section 226(b) 

13 or section 226A of the Social Security Act 

14 (42 U.S.C. 426(b); 426–1); 

15 (ii) is enrolled for benefits under part 

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

17 and 

18 (iii) would not, but for the provisions 

19 of and amendments made by paragraphs 

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

21 issue of a Medicare supplemental policy 

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

23 1882(s) of such Act (42 U.S.C. 1395ss(s)). 

24 (b) GUARANTEED ISSUE OF MEDIGAP POLICIES FOR

25 MEDICARE ADVANTAGE AND MEDICAID ENROLLEES, 


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1 CERTAIN VETERANS, AND OTHER INDIVIDUALS DETER2 MINED APPROPRIATE BY THE SECRETARY; TREATMENT

3 OF INDIVIDUALS WITH COBRA.— 

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

5 Social Security Act (42 U.S.C. 1395ss(s)(3)) is 

6 amended— 

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

8 end the following new clauses: 

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

10 Advantage plan under part C for not less than 12 

11 months and subsequently disenrolled from such plan 

12 and elects to receive benefits under this title through 

13 the original Medicare fee-for-service program under 

14 parts A and B. 

15 ‘‘(viii) The individual— 

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

17 under part A and enrolled for benefits under 

18 part B; and 

19 ‘‘(II) either— 

20 ‘‘(aa) is eligible for medical assistance 

21 under a State plan or waiver under title 

22 XIX based on a reduction of income of the 

23 individual based on costs incurred for med24 ical or other remedial care and was en25 rolled in such plan or waiver; or 


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1 ‘‘(bb) was otherwise eligible for med2 ical assistance under a State plan or waiv3 er under title XIX and subsequently lost 

4 eligibility for such medical assistance. 

5 ‘‘(ix) The individual— 

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

7 under part A and enrolled for benefits under 

8 part B; 

9 ‘‘(II) is a covered beneficiary (as that term 

10 is defined in section 1072(5) of title 10, United 

11 States Code), entitled to medical and dental 

12 care under chapter 55 of that title, who was re13 ceiving medical care at a facility of the uni14 formed services through such entitlement; and 

15 ‘‘(III) no longer receives such care at such 

16 facility because— 

17 ‘‘(aa) such facility has been closed; 

18 ‘‘(bb) such facility no longer offers 

19 such care; 

20 ‘‘(cc) the individual no longer meets 

21 the requirements for eligibility for such 

22 care; or 

23 ‘‘(dd) the individual moved away from 

24 the facility. 


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1 ‘‘(x) The individual meets such other require2 ments that the Secretary, through notice and com3 ment rulemaking, determines appropriate.’’; 

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

5 inserting the following: 

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

7 of an individual described in clause (vi), (vii), (viii), 

8 (ix), or (x) of subparagraph (B), a Medicare supple9 mental policy described in this subparagraph shall 

10 include any Medicare supplemental policy.’’; and 

11 (C) in subparagraph (E)— 

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

13 the end; 

14 (ii) in clause (v), by striking the pe15 riod at the end and inserting a semicolon; 

16 and 

17 (iii) by adding at the end the fol18 lowing new clauses— 

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

20 subparagraph (B)(vii), the annual, coordinated elec21 tion period (as defined in section 1851(e)(3)(B)) or 

22 a continuous open enrollment period (as defined in 

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

24 disenrolls from a Medicare Advantage plan under 

25 part C; 


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

2 subparagraph (B)(viii) who is eligible for medical as3 sistance under a State plan or waiver under title 

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

5 as is specified by the Secretary; 

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

7 subparagraph (B)(viii) who is eligible for medical as8 sistance under a State plan or waiver under title 

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

10 beginning on the date that the individual receives a 

11 notice of cessation of such individual’s eligibility for 

12 medical assistance under the State plan or waiver 

13 under title XIX and ending on the date that is six 

14 months after the individual receives such notice; 

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

16 subparagraph (B)(ix), during the 63 days after the 

17 individual is no longer eligible to receive the care 

18 from the facility described in such subparagraph; 

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

20 subparagraph (B)(x), such period as is specified by 

21 the Secretary; and’’. 

22 (2) TREATMENT OF INDIVIDUALS WITH

23 COBRA.— 

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

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


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1 1395ss(s)(3)), as amended by subsection (a) 

2 and paragraph (1), is further amended— 

3 (i) in subparagraph (B)(i) by insert4 ing ‘‘or, in the case of an individual en5 rolled in such an employee welfare benefit 

6 plan pursuant to a COBRA continuation 

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

8 of the Public Health Service Act), that the 

9 individual disenrolls from such plan and 

10 enrolls under part B’’ before the period at 

11 the end; and 

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

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

14 following new clause: 

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

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

17 welfare benefit plan described in such subparagraph 

18 pursuant to a COBRA continuation provision (as de19 fined in section 2791(d)(4) of the Public Health 

20 Service Act) and who disenrolls from such plan and 

21 enrolls under part B, the period beginning on the 

22 date that is 60 days before the effective date of such 

23 disenrollment and ending on the date that is 63 days 

24 after such effective date.’’. 


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1 (B) TECHNICAL CORRECTION.—Section 

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

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

4 (i) by striking ‘‘2701(c)’’ and insert5 ing ‘‘2704(c)’’; and 

6 (ii) by striking ‘‘2701(a)(3)’’ and in7 serting ‘‘2704(a)(3)’’. 

8 (3) EFFECTIVE DATE.—The amendments made 

9 by paragraphs (1) and (2)(A) shall apply to Medi10 care supplemental policies effective on or after Janu11 ary 1, 2023. 

12 (c) MEDPAC STUDIES AND REPORTS.— 

13 (1) ANNUAL OPEN ENROLLMENT.— 

14 (A) STUDY.—The Medicare Payment Advi15 sory Commission (in this section referred to as 

16 the ‘‘Commission’’) shall conduct a study on 

17 providing an open enrollment period for Medi18 care supplemental policies (under section 1882 

19 of the Social Security Act (42 U.S.C. 1395ss)) 

20 under which an individual could enroll in such 

21 a policy with guaranteed issue protections. Such 

22 study shall include an analysis of— 

23 (i) the impact of the ‘‘birthday rule’’ 

24 in California and Oregon, where an indi25 vidual can enroll with such protections in 


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1 a new policy with the same or lesser bene2 fits within 30 days of their birthday; 

3 (ii) the impact of such birthday rule if 

4 such rule permitted the individual to enroll 

5 with such protections in any policy; and 

6 (iii) other areas determined appro7 priate by the Commission. 

8 (B) REPORT.—Not later than 2 years after 

9 the date of the enactment of this Act, the Com10 mission shall submit to Congress a report on 

11 the study conducted under subparagraph (A), 

12 together with recommendations for such legisla13 tion and administrative action as the Commis14 sion determines appropriate. 

15 (2) EQUITABLE RELIEF.— 

16 (A) STUDY.—The Medicare Payment Advi17 sory Commission (in this section referred to as 

18 the ‘‘Commission’’) shall conduct a study on the 

19 Secretary of Health and Human Services grant20 ing equitable relief for enrollment in a Medicare 

21 supplemental policy (under section 1882 of the 

22 Social Security Act (42 U.S.C. 1395ss)) in a 

23 similar manner as the Secretary grants such re24 lief for enrollment under part B of the Medi25 care program. 


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1 (B) REPORT.—Not later than 2 years after 

2 the date of the enactment of this Act, the Com3 mission shall submit to Congress a report on 

4 the study conducted under subparagraph (A), 

5 together with recommendations for such legisla6 tion and administrative action as the Commis7 sion determines appropriate. 

8 (d) OUTREACH PLAN.— 

9 (1) IN GENERAL.—The Secretary of Health and 

10 Human Services shall develop an outreach plan to 

11 notify individuals (including individuals described in 

12 clause (viii) of section 1882(s)(3)(B) of the Social 

13 Security Act (42 U.S.C. 1395ss(s)(3)(B)), as added 

14 by subsection (b)(1)) that may be affected by the 

15 provisions of, and amendments made by, this section 

16 regarding such provisions and amendments. 

17 (2) CONSULTATION.—In implementing the out18 reach plan developed under paragraph (1), the Sec19 retary of Health and Human Services shall consult 

20 with consumer advocates, brokers, insurers, the Na21 tional Association of Insurance Commissioners, and 

22 State Health Insurance Assistance Programs. 


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1 SEC. 3. LIMITATIONS ON PRICING DISCRIMINATION. 

2 (a) IN GENERAL.—Section 1882 of the Social Secu3 rity Act (42 U.S.C. 1395ss) is amended by adding at the 

4 end the following new subsection: 

5 ‘‘(aa) DEVELOPMENT OF NEW STANDARDS RELAT6 ING TO PRICING DISCRIMINATION.— 

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

8 the National Association of Insurance Commis9 sioners to review and revise the standards for all 

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

11 the core benefit package, in order to provide cov12 erage consistent with paragraph (2). Such revisions 

13 shall be made consistent with the rules applicable 

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

15 ‘1991 NAIC Model Regulation’ deemed a reference 

16 to the NAIC Model Regulation as most recently up17 dated by the National Association of Insurance 

18 Commissioners to reflect previous changes in law 

19 and the reference to ‘date of enactment of this sub20 section’ deemed a reference to the date of enactment 

21 of this subsection). 

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

23 Under the revised standards, coverage shall not be 

24 available under a Medicare supplemental insurance 

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


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1 conforming to the other applicable requirements of 

2 this section— 

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

4 of the policy because of the age or health status 

5 of the individual to whom the policy is issued; 

6 ‘‘(B) does not, to an extent that jeopard7 izes the access to such policy for individuals 

8 who are eligible to participate in the program 

9 under this title because the individuals are indi10 viduals described in paragraph (2) or (3) of sec11 tion 1811, discriminate in the pricing of the 

12 policy because the individual to whom the policy 

13 is issued is so eligible to participate in such 

14 program because the individual is an individual 

15 so described in such a paragraph; and 

16 ‘‘(C) does not establish premiums applica17 ble under such policy on a basis that would 

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

19 a metropolitan statistical area. 

20 ‘‘(3) APPLICATION DATE.—The revised stand21 ards shall apply to benefit packages sold, issued, or 

22 renewed under this section to an individual who first 

23 become entitled to benefits under part A or first en24 rolls in part B on or after January 1, 2023.’’. 


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

2 of the Social Security Act (42 U.S.C. 1395ss(o)(1)) is 

3 amended by striking ‘‘, and (y)’’ and inserting ‘‘(y), and 

4 (aa)’’. 

5 SEC. 4. CLARIFICATION REGARDING STANDARDIZED 

6 MEDIGAP PLANS. 

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

8 1395ss), as amended by section (3), is amended by adding 

9 at the end the following new subsection: 

10 ‘‘(bb) LIMITATION ON ADDITIONAL BENEFITS.—A 

11 standard benefit package established under this section 

12 may not include benefits that are in addition to the stand13 ard benefits under the package. An issuer of a Medicare 

14 supplemental policy may offer such additional standard15 ized benefits through a separate rider.’’. 

16 SEC. 5. IMPROVING INFORMATION AVAILABLE TO MEDI17 CARE BENEFICIARIES. 

18 (a) CLARIFYING BENEFICIARY OPTIONS ON THE

19 MEDICARE PLAN FINDER WEBSITE.—Section 1804 of the 

20 Social Security Act (42 U.S.C. 1395b–2) is amended by 

21 adding at the end the following new subsections: 

22 ‘‘(e) In the case that the Secretary provides for a 

23 Medicare plan finder Internet website of the Centers for 

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


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1 Secretary shall, with respect to such website and in ac2 cordance with subsection (f)— 

3 ‘‘(1) consult with at least one independent enti4 ty that represents consumers in the development of 

5 such website; 

6 ‘‘(2) make available on such website— 

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

8 to provide to individuals entitled to benefits 

9 under part A or enrolled under part B informa10 tion to assist such individuals in understanding 

11 the restrictions on providers and potential costs 

12 entailed by their decisions regarding enrollment 

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

14 Medicare supplemental policies under section 

15 1882; 

16 ‘‘(B) a review of out-of-pocket expendi17 tures, including deductibles, copayments, coin18 surance, monthly premiums, and estimated an19 nual out-of-pocket costs, displayed overall and 

20 by components, based on the best available in21 formation as determined by the Secretary and 

22 based on the individual’s specific health status; 

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

24 2023, information regarding the rules that, in 

25 each State, pertain to guaranteed issue of MediVerDate Sep 11 2014 20:59 Aug 16, 2019 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S2428.IS S2428

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1 care supplemental health insurance policies 

2 prior to implementation of the provisions of the 

3 Medigap Consumer Protection Act of 2019 and, 

4 in the case that a State has no such rules per5 taining to guaranteed issue of such policies, 

6 clear language explaining the implications of 

7 such lack of rules for individuals with pre-exist8 ing conditions; and 

9 ‘‘(D) clear information on local resources 

10 for individuals, such as information on their 

11 State Health Insurance Assistance Program 

12 (SHIP); 

13 ‘‘(3) not later than January 1, 2021, and peri14 odically thereafter, perform a review of such website 

15 in order to ensure that such website makes available 

16 to individuals entitled to benefits under part A or 

17 enrolled under part B the information that the Sec18 retary determines is necessary for such individuals 

19 to make informed choices regarding their options 

20 under the program under this title; and 

21 ‘‘(4) not later than 12 months after the last 

22 day of each period for the request for information 

23 under subsection (f), update such website, taking 

24 into consideration the information collected pursuant 

25 to such subsection, to clarify the presentation of conVerDate Sep 11 2014 20:59 Aug 16, 2019 Jkt 089200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S2428.IS S2428

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1 sumer options for Medicare supplemental health in2 surance policy options, including by presenting such 

3 information in a manner calculated to be understood 

4 by the average consumer and in a manner that— 

5 ‘‘(A) improves consumer access to informa6 tion regarding the applicable premiums under 

7 such policy options as of the date on which such 

8 website is so updated; 

9 ‘‘(B) facilitates consumers’ ability to com10 pare and sort policy options and premium infor11 mation across plan offerings in a given location; 

12 ‘‘(C) clarifies and explains differences in 

13 policy value; 

14 ‘‘(D) rates and explains the financial sta15 bility of issuers of such policies; 

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

17 different policies; 

18 ‘‘(F) provides information regarding the 

19 guaranteed issue requirements that apply to 

20 Medicare supplemental health insurance policies 

21 under section 1882(s); and 

22 ‘‘(G) includes such general information as 

23 is determined by the Secretary to be necessary 

24 for individuals entitled to benefits under part A 

25 or enrolled under part B to understand costs 


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1 under MA plans available pursuant to part C 

2 and prescription drug plans available pursuant 

3 to part D. 

4 ‘‘(f) Not later than 6 months after the date of the 

5 enactment of this subsection and beginning on December 

6 7 of each year thereafter, the Secretary of Health and 

7 Human Services shall provide an opportunity for public 

8 comment during which the Secretary requests informa9 tion, including recommendations, from stakeholders re10 garding potential improvements to the presentation of 

11 Medicare supplemental health insurance policy options 

12 under section 1882 on the Medicare plan finder Internet 

13 website of the Centers for Medicare & Medicaid Services 

14 (or a successor website). 

15 ‘‘(g) With respect to any information that the Sec16 retary makes available on the Medicare plan finder Inter17 net website of the Centers for Medicare & Medicaid Serv18 ices (or a successor website) pursuant to subsection (e), 

19 the Secretary shall, prior to making such information 

20 available— 

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

22 Association of Insurance Commissioners, an oppor23 tunity for consumer testing of such information; 


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

2 of such information with interested stakeholders; 

3 and 

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

5 with respect to such information.’’. 

6 (b) IMPROVED INFORMATION ON MEDIGAP.—As the 

7 Secretary of Health and Human Services works to update 

8 the materials provided to Medicare beneficiaries regarding 

9 the Medicare program and Medicare supplemental policies 

10 based on the provisions of, and amendments made by, this 

11 Act, the Secretary shall consult with at least one inde12 pendent entity that represents consumers. 

13 (c) EQUAL TREATMENT BETWEEN INFORMATION ON

14 THE MEDICARE FEE-FOR-SERVICE PROGRAM AND THE

15 MEDICARE ADVANTAGE PROGRAM.—The Secretary of 

16 Health and Human Services shall ensure that— 

17 (1) any information distributed or otherwise 

18 made available to the public and related to the Medi19 care program does not display a bias towards the 

20 Medicare Advantage program over the original Medi21 care fee-for-service program, or vice versa; and 

22 (2) the volume of such information is equally 

23 weighted between such programs. 


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1 SEC. 6. BROKER CONFLICTS OF INTEREST. 

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

3 1320a–7h) is amended— 

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

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

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

7 later than 6 months after the date of the enactment 

8 of such subsection),’’; and 

9 (2) by adding at the end the following new sub10 section: 

11 ‘‘(f) APPLICATION TO MEDIGAP INSURANCE BRO12 KERS.— 

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

14 12 months after the date of enactment of this sub15 section, each issuer of a Medicare supplemental 

16 health insurance policy shall annually submit to the 

17 Secretary a report regarding payments or other 

18 transfers of value made during the previous year to 

19 agents, brokers, and other third parties representing 

20 such policy. Each such report shall include the fol21 lowing information, with respect to such a payment 

22 or other transfer of value: 

23 ‘‘(A) The name of the recipient of the pay24 ment or other transfer of value. 

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


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

2 transfer of value. 

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

4 transfer of value was provided. 

5 ‘‘(E) A description of the form of the pay6 ment or transfer of value. 

7 ‘‘(F) Any other categories of information 

8 the Secretary determines appropriate. 

9 ‘‘(2) APPLICATION OF TRANSPARENCY SYS10 TEM.—The provisions of subsections (b) through (d) 

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

12 information required to be reported under such 

13 paragraph, and agents, brokers, and other third par14 ties described in such paragraph in the same manner 

15 and to the same extent as such provisions apply to 

16 an applicable manufacturer, information required to 

17 be reported under subsection (a), and a covered re18 cipient.’’. 

19 SEC. 7. PROTECTING AGAINST HIGH OUT-OF-POCKET EX20 PENDITURES FOR MEDICARE FEE-FOR-SERV21 ICE BENEFITS. 

22 Title XVIII of the Social Security Act (42 U.S.C. 

23 1395 et seq.) is amended by adding at the end the fol24 lowing new section: 


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1 ‘‘PROTECTION AGAINST HIGH OUT-OF-POCKET

2 EXPENDITURES

3 ‘‘SEC. 1899C. (a) IN GENERAL.—Notwithstanding 

4 any other provision of this title, in the case of an indi5 vidual entitled to, or enrolled for, benefits under part A 

6 or enrolled in part B, if the amount of the out-of-pocket 

7 cost-sharing of such individual for a year (beginning with 

8 2022) equals or exceeds the annual out-of-pocket limit 

9 under subsection (b) for that year— 

10 ‘‘(1) the amount otherwise payable under part 

11 A and the total amount of expenses incurred by the 

12 individual which would (except for this section) con13 stitute incurred expenses for which benefits are pay14 able under part B, shall be 100 percent of such 

15 amount for the remainder of that year; and 

16 ‘‘(2) the individual shall not be responsible for 

17 out-of-pocket cost-sharing incurred during the re18 mainder of that year. 

19 ‘‘(b) ANNUAL OUT-OF-POCKET LIMIT.— 

20 ‘‘(1) IN GENERAL.—The amount of the annual 

21 out-of-pocket limit under this subsection shall be— 

22 ‘‘(A) for 2022, $5,500; or 

23 ‘‘(B) for a subsequent year, the amount 

24 specified in this subsection for the preceding 

25 year increased or decreased by the percentage 


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1 change in the Consumer Price Index for All 

2 Urban Consumers for the 12-month period end3 ing with June of such preceding year. 

4 ‘‘(2) ROUNDING.—If any amount determined 

5 under paragraph (1)(B) is not a multiple of $5, such 

6 amount shall be rounded to the nearest multiple of 

7 $5. 

8 ‘‘(c) OUT-OF-POCKET COST-SHARING DEFINED.— 

9 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

10 and (3), in this section, the term ‘out-of-pocket cost11 sharing’ means, with respect to an individual, the 

12 amount of the expenses incurred by the individual 

13 that are attributable to— 

14 ‘‘(A) deductibles, coinsurance and copay15 ments applicable under part A or B; or 

16 ‘‘(B) for items and services that would 

17 have otherwise been covered under part A or B 

18 but for the exhaustion of those benefits. 

19 ‘‘(2) CERTAIN COSTS NOT INCLUDED.— 

20 ‘‘(A) NON-COVERED ITEMS AND SERV21 ICES.—Expenses incurred for items and serv22 ices which are not covered under part A or B 

23 shall not be considered incurred expenses for 

24 purposes of determining out-of-pocket cost25 sharing under paragraph (1). 


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•S 2428 IS

1 ‘‘(B) ITEMS AND SERVICES NOT FUR2 NISHED ON AN ASSIGNMENT-RELATED BASIS.— 

3 If an item or service is furnished to an indi4 vidual under this title and is not furnished on 

5 an assignment-related basis, any additional ex6 penses the individual incurs above the amount 

7 the individual would have incurred if the item 

8 or service was furnished on an assignment-re9 lated basis shall not be considered incurred ex10 penses for purposes of determining out-of-pock11 et cost-sharing under paragraph (1). 

12 ‘‘(3) SOURCE OF PAYMENT.—For purposes of 

13 paragraph (1), the Secretary shall consider expenses 

14 to be incurred by the individual without regard to 

15 whether the individual or another person, including 

16 a State program, an employer, a Medicare supple17 mental policy, or other third-party coverage, has 

18 paid for such expenses. 

19 ‘‘(d) ANNOUNCEMENT OF THE ANNUAL OUT-OF20 POCKET LIMIT.—The Secretary shall (beginning in 2021) 

21 announce (in a manner intended to provide notice to all 

22 interested parties) the annual out-of-pocket limit under 

23 this section that will be applicable for the succeeding 

24 year.’’. 


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•S 2428 IS

1 SEC. 8. STUDY AND REPORT ON VARIATIONS AMONG 

2 MEDIGAP PLANS. 

3 (a) STUDY.—The Comptroller General of the United 

4 States (in this section referred to as the ‘‘Comptroller 

5 General’’) shall conduct a study on the variations among 

6 Medicare supplemental policies under section 1882 of the 

7 Social Security Act (42 U.S.C. 1395ss). Such study shall 

8 include an analysis of the following: 

9 (1) How the variations among such policies im10 pacts Medicare beneficiaries’ choices. 

11 (2) Ways to improve standardization and tools 

12 to help Medicare beneficiaries make informed choices 

13 with respect to such policies. 

14 (3) Other items determined appropriate by the 

15 Comptroller General. 

16 (b) REPORT.—Not later than 2 years after the date 

17 of the enactment of this Act, the Comptroller General shall 

18 submit to Congress a report on the study conducted under 

19 subsection (a), together with recommendations for such 

20 legislation and administrative action as the Comptroller 

21 General determines appropriate. 

Æ 


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