I 
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 supple-
mental 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 with-
in 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 Representa-
tives 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’’. 
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SEC. 2. GUARANTEED ISSUE OF MEDIGAP POLICIES TO ALL 
MEDICARE BENEFICIARIES. 
(a) IN GENERAL.—Section 1882(s) of the Social Se-
curity 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 Medi-
care supplemental policy prior to the effective date 
of this Act. 
(2) LIMIT.—The phase-in period under para-
graph (1) shall not exceed 5 years. 
(c) SEPARATE PREMIUM CLASS.— 
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(1) IN GENERAL.—Subject to paragraph (2), 
any individuals enrolled under a Medicare supple-
mental 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 Medi-
care supplemental policy prior to January 1, 2015. 
(d) ADDITIONAL ENROLLMENT PERIOD FOR CER-
TAIN INDIVIDUALS.— 
(1) ONE-TIME ENROLLMENT PERIOD.— 
(A) IN GENERAL.—In the case of an indi-
vidual 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 indi-
vidual’s choosing. 
(B) PERIOD.—The enrollment period es-
tablished 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 de-
scribed in this paragraph is an individual who— 
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(A) is entitled to hospital insurance bene-
fits 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 eligi-
ble for the guaranteed issue of a Medicare sup-
plemental policy under section 1882(s)(2) of 
such Act (42 U.S.C. 1395ss(s)(2)). 
(3) OUTREACH PLAN.—The Secretary shall de-
velop an outreach plan to notify individuals de-
scribed 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 EN-
ROLLEES. 
(a) IN GENERAL.—Section 1882(s)(3) of the Social 
Security Act (42 U.S.C. 1395ss(s)(3)), as amended by sec-
tion 2, is amended— 
(1) in subparagraph (B), by adding at the end 
the following new clauses: 
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‘‘(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 in-
serting the following: 
‘‘(iii) Subject to subsection (v)(1), for purposes of an 
individual described in clause (vi), (vii), or (viii) of sub-
paragraph (B), a Medicare supplemental policy described 
in this subparagraph shall include any Medicare supple-
mental policy.’’; and 
(3) in subparagraph (E)— 
(A) in clause (iv), by striking ‘‘and’’ at the 
end; 
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(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 elec-
tion 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 indi-
vidual receives such notice.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to Medicare supplemental poli-
cies effective on or after January 1, 2011. 
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SEC. 4. ENROLLMENT OF INDIVIDUALS WITH END STAGE 
RENAL DISEASE IN MEDICARE ADVANTAGE. 
(a) IN GENERAL.—Section 1851(a) of the Social Se-
curity Act (42 U.S.C. 1395w–21(a)) is amended by strik-
ing paragraph (3) and inserting the following: 
‘‘(3) 
MEDICARE+CHOICE
ELIGIBLE
INDI-
VIDUAL.—In this title, the term ‘Medicare+Choice 
eligible individual’ means an individual who is enti-
tled 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 organi-
zation 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 
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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 sec-
ond 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 subpara-
graph 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 para-
graph (5); and 
(2) by inserting after paragraph (3) the fol-
lowing 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 pol-
icy with a particular benefit package may change to an-
other such policy if such other policy is offered by a dif-
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ferent issuer and available for issuance to new enrollees 
by such issuer and if such other policy has the same ben-
efit 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 enroll-
ment periods under parts C and D. A change in enroll-
ment 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 experi-
ence, 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 
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Medicare supplemental policies, the Secretary may permit 
the new issuer of the Medicare supplemental policy to 
apply such limited pre-existing conditions and such pre-
mium rating rules as may be appropriate.’’. 
Æ 
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