I 
117TH CONGRESS 
1ST SESSION H. R. 4640 
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 22, 2021 
Mr. DOGGETT (for himself, Mr. BLUMENAUER, Mr. CARTWRIGHT, Ms. CHU, 
Mr. CLEAVER, Mr. COHEN, Mr. DEFAZIO, Mrs. DINGELL, Mr. EVANS, 
Mr. GRIJALVA, Mrs. HAYES, Ms. JOHNSON of Texas, Ms. KAPTUR, Mr. 
KHANNA, Ms. LEE
of California, Mr. LEVIN
of Michigan, Mr. 
LOWENTHAL, Mrs. CAROLYN B. MALONEY of New York, Mr. MFUME, 
Mr. NADLER, Ms. NORTON, Mr. PERLMUTTER, Ms. PORTER, Ms. SCHA-
KOWSKY, Ms. SEWELL, Ms. SPEIER, Mr. SUOZZI, Mr. TAKANO, Ms. 
TITUS, Mr. THOMPSON of California, Mr. TONKO, Ms. DELAURO, and 
Mrs. WATSON COLEMAN) introduced the following bill; which was re-
ferred to the Committee on Ways and Means, and in addition to the 
Committee on Energy and Commerce, for a period to be subsequently de-
termined 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 supple-
mental health insurance policies. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Close the Medigap Act 
of 2021’’. 
SEC. 2. GUARANTEED ISSUE. 
(a) IN GENERAL.—Section 1882(s) of the Social Se-
curity Act (42 U.S.C. 1395ss(s)) is amended to read as 
follows: 
‘‘(s)(1) Subject to paragraph (2), the issuer of a 
medicare supplemental policy may not, in the case of an 
individual entitled to benefits under part A and enrolled 
under part B— 
‘‘(A) deny or condition the issuance or effective-
ness of a medicare supplemental policy, or discrimi-
nate in the pricing of the policy, because of health 
status, claims experience, receipt of health care, or 
medical condition; 
‘‘(B) exclude benefits based on a preexisting 
condition; 
‘‘(C) provide any time period applicable to pre-
existing conditions, waiting periods, elimination peri-
ods, and probationary periods for any benefit; 
‘‘(D) deny or condition the issuance or effec-
tiveness of the policy (including the imposition of 
any exclusion of benefits under the policy based on 
a preexisting condition) or discriminate in the pric-
ing of the policy (including the adjustment of pre-
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mium rates) of an individual on the basis of the ge-
netic information with respect to such individual; 
‘‘(E) deny or condition the issuance or effective-
ness of a medicare supplemental policy that is of-
fered and is available for issuance to new enrollees 
by such issuer; or 
‘‘(F) establish any period limiting enrollment 
under a medicare supplemental policy to such period 
for any individual. 
‘‘(2) Paragraph (1) shall not apply to an individual 
entitled to benefits under part A solely by reason of section 
226A. 
‘‘(3) Nothing in this subsection or in subparagraphs 
(A) or (B) of subsection (x)(2) shall be construed to limit 
the ability of an issuer of a medicare supplemental policy 
from, to the extent otherwise permitted under this title— 
‘‘(A) denying or conditioning the issuance or ef-
fectiveness of the policy or increasing the premium 
for an employer based on the manifestation of a dis-
ease or disorder of an individual who is covered 
under the policy; or 
‘‘(B) increasing the premium for any policy 
issued to an individual based on the manifestation of 
a disease or disorder of an individual who is covered 
under the policy (in such case, the manifestation of 
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a disease or disorder in one individual cannot also 
be used as genetic information about other group 
members.’’. 
(b) OUTREACH PLAN.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall develop an outreach plan to 
notify individuals entitled to benefits under part A 
or enrolled under part B of title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.) of the effects 
of the amendment made by subsection (a). 
(2) CONSULTATION.—In implementing the out-
reach plan developed under paragraph (1), the Sec-
retary shall consult with consumer advocates, bro-
kers, insurers, the National Association of Insurance 
Commissioners, and State Health Insurance Assist-
ance Programs. 
(c) EFFECTIVE DATE; PHASE-IN AUTHORITY.— 
(1) EFFECTIVE DATE.—Subject to paragraph 
(2), the amendment made by subsection (a) shall 
apply to medicare supplemental policies effective on 
or after January 1, 2022. 
(2) PHASE-IN AUTHORITY.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary of Health and Human 
Services may phase in the implementation of 
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the amendment made under subsection (a) 
(with such phase-in beginning on or after Janu-
ary 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. 
(B) PHASE-IN PERIOD MAY NOT EXCEED 5 
YEARS.—The Secretary of Health and Human 
Services shall ensure that the amendment made 
by subsection (a) is fully implemented by not 
later than January 1, 2027. 
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 be-
fore January 1, 2022, at least 75 percent of the 
aggregate amount of premiums collected in the 
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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 ag-
gregate 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 As-
sociation of Insurance Commissioners may 
recommend to the Secretary with respect 
to such policies for purposes of this para-
graph; and’’. 
SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION. 
(a) IN GENERAL.—Section 1882 of the Social Secu-
rity 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 RELAT-
ING TO PRICING DISCRIMINATION.— 
‘‘(1) IN GENERAL.—The Secretary shall request 
the National Association of Insurance Commis-
sioners to review and revise the standards for all 
benefit packages under subsection (p)(1), including 
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the core benefit package, in order to provide cov-
erage 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 up-
dated by the National Association of Insurance 
Commissioners to reflect previous changes in law 
and the reference to ‘date of enactment of this sub-
section’ 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 indi-
vidual to whom the policy is issued; 
‘‘(B) does not, to an extent that jeopard-
izes the access to such policy for individuals 
who are eligible to participate in the program 
under this title because the individuals are indi-
viduals described in paragraph (2) or (3) of sec-
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tion 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 applica-
ble 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 stand-
ards 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 en-
rolls 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 strik-
ing ‘‘, and (y)’’ and inserting ‘‘(y), and (aa)’’. 
SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDI-
CARE 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 
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Medicare & Medicaid Services (or a successor website), the 
Secretary shall, with respect to such website and in ac-
cordance 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 informa-
tion 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 expendi-
tures, including deductibles, copayments, coin-
surance, monthly premiums, and estimated an-
nual out-of-pocket costs, displayed overall and 
by components, based on the best available in-
formation 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 medi-
care supplemental health insurance policies 
prior to implementation of the provisions of the 
Close the Medigap Act of 2021 and, in the case 
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that a State has no such rules pertaining to 
guaranteed issue of such policies, clear lan-
guage explaining the implications of such lack 
of rules for individuals with pre-existing condi-
tions; 
‘‘(2) not later than January 1, 2020, and peri-
odically 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 Sec-
retary 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 con-
sumer options for medicare supplemental health in-
surance 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 informa-
tion regarding the applicable premiums under 
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such policy options as of the date on which such 
website is so updated; 
‘‘(B) facilitates consumers’ ability to com-
pare and sort policy options and premium infor-
mation across plan offerings in a given location; 
‘‘(C) clarifies and explains differences in 
policy value; 
‘‘(D) rates and explains the financial sta-
bility 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 
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Human Services shall provide an opportunity for public 
comment during which the Secretary requests informa-
tion, including recommendations, from stakeholders re-
garding 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 Sec-
retary makes available on the Medicare plan finder inter-
net website of the Centers for Medicare & Medicaid Serv-
ices (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 oppor-
tunity 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.’’. 
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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 enact-
ment of such subsection),’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(f) APPLICATION TO MEDIGAP INSURANCE BRO-
KERS.— 
‘‘(1) IN GENERAL.—Beginning not later than 
12 months after the date of enactment of this sub-
section, 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 fol-
lowing information, with respect to such a payment 
or other transfer of value: 
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‘‘(A) The name of the recipient of the pay-
ment 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 pay-
ment or transfer of value. 
‘‘(F) Any other categories of information 
the Secretary determines appropriate. 
‘‘(2) APPLICATION
OF
TRANSPARENCY
SYS-
TEM.—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 par-
ties 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 re-
cipient.’’. 
Æ 
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