Protecting Medicare Beneficiaries with Pre-Existing Conditions Act

To amend title XVIII of the Social Security Act to provide for the guaranteed issue of Medigap policies to all Medigap-eligible Medicare beneficiaries and Medicare Advantage enrollees, and for other purposes. 1. Short title This Act may be cited as the Protecting Medicare Beneficiaries with Pre-Existing Conditions Act 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) (A) in paragraph (2)(A), by striking 65 years of age or older and is enrolled for benefits under part B 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 (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, 2023. (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, 2023) 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, 2028. (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 of title XVIII of the Social Security Act ( 42 U.S.C. 1395c 42 U.S.C. 426(b) (ii) is enrolled for benefits under part B of such Act ( 42 U.S.C. 1395j (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 enrollees (1) In general Section 1882(s)(3) of the Social Security Act ( 42 U.S.C. 1395ss(s)(3) (A) in subparagraph (B), by adding at the end the following new clause: (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. ; (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) or (vii) 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 (ii) in clause (v), by striking the period at the end and inserting ; and (iii) by adding at the end the following new clause— (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. . (2) Effective date The amendments made by paragraph (1) shall apply to medicare supplemental policies effective on or after January 1, 2023.

Summary: Protecting Medicare Beneficiaries with Pre-Existing Conditions Act This bill expands guaranteed issue rights with respect to Medigap policies (Medicare supplemental health insurance policies) to all beneficiaries regardless of age. (Guaranteed issue rights require that a policy be offered to any eligible applicant without regard to health status.) The bill provides for a phased implementation over a five-year period, with full implementation by January 1, 2028.