I 
114TH CONGRESS 
2D SESSION 
H. R. 6265 
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 
SEPTEMBER 28, 2016 
Mr. MCDERMOTT (for himself, Mr. LEVIN, and Mr. CONYERS) 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 consider-
ation 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, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medigap Consumer 
Protection Act of 2016’’. 
SEC. 2. GUARANTEED ISSUE. 
(a) GUARANTEED ISSUE OF MEDIGAP POLICIES TO 
ALL MEDIGAP-ELIGIBLE MEDICARE BENEFICIARIES.— 
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(1) IN GENERAL.—Section 1882(s) of the So-
cial Security Act (42 U.S.C. 1395ss(s)) is amend-
ed— 
(A) 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 en-
rolled 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’’; and 
(D) in paragraph (3)(B)(vi), by striking 
‘‘at age 65’’. 
(2) EFFECTIVE DATE; PHASE-IN AUTHORITY.— 
(A) EFFECTIVE
DATE.—Subject to sub-
paragraph (B), the amendments made by para-
graph (1) shall apply to medicare supplemental 
policies effective on or after January 1, 2020. 
(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 
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(1) (with such phase-in beginning on or 
after January 1, 2020) in such manner as 
the Secretary determines appropriate in 
order to minimize any adverse impact on 
individuals enrolled under a medicare sup-
plemental policy. 
(ii) PHASE-IN PERIOD MAY NOT EX-
CEED 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 Janu-
ary 1, 2025. 
(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 en-
rollment period during which such an indi-
vidual may enroll in any medicare supple-
mental 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 
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under paragraph (2) is completed and end 
6 months after such date. 
(B) INDIVIDUAL
DESCRIBED.—An indi-
vidual described in this paragraph is an indi-
vidual who— 
(i) is entitled to hospital insurance 
benefits under part A under section 226(b) 
or section 226A of the Social Security Act 
(42 U.S.C. 426(b); 426–1); 
(ii) is enrolled for benefits under part 
B of such Act (42 U.S.C. 1395j et seq.); 
and 
(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 individ-
uals described in subparagraph (B) of the 
one-time enrollment period established 
under subparagraph (A). 
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(ii) 
CONSULTATION.—In 
imple-
menting the outreach plan developed under 
clause (i), the Secretary shall consult with 
consumer advocates, brokers, insurers, the 
National Association of Insurance Commis-
sioners, and State Health Insurance As-
sistance Programs. 
(b) GUARANTEED ISSUE OF MEDIGAP POLICIES FOR 
MEDICARE
ADVANTAGE
AND
MEDICAID
ENROLLEES; 
TREATMENT OF INDIVIDUALS WITH COBRA.— 
(1) IN
GENERAL.—Section 1882(s)(3) of the 
Social Security Act (42 U.S.C. 1395ss(s)(3)), as 
amended by subsection (a), is further amended— 
(A) 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; and 
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‘‘(II) either— 
‘‘(aa) is eligible for medical assistance 
under a State plan or waiver under title 
XIX based on a reduction of income of the 
individual based on costs incurred for med-
ical or other remedial care and was en-
rolled in such plan or waiver; or 
‘‘(bb) was otherwise eligible for med-
ical assistance under a State plan or waiv-
er under title XIX and subsequently lost 
eligibility for such medical assistance.’’; 
(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), (vii), or 
(viii) 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’’ at 
the end; 
(ii) in clause (v), by striking the pe-
riod at the end and inserting a semicolon; 
and 
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(iii) by adding at the end the fol-
lowing 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; 
‘‘(vii) in the case of an individual described in 
subparagraph (B)(viii) who is eligible for medical as-
sistance under a State plan or waiver under title 
XIX for a reason described in item (aa), such period 
as is specified by the Secretary; 
‘‘(viii) in the case of an individual described in 
subparagraph (B)(viii) who is eligible for medical as-
sistance under a State plan or waiver under title 
XIX for a reason described in item (bb), 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 four 
months after the individual receives such notice; 
and’’. 
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(2) 
TREATMENT
OF
INDIVIDUALS
WITH 
COBRA.— 
(A) IN GENERAL.—Section 1882(s)(3) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ss(s)(3)), as amended by subsection (a) 
and paragraph (1), is further amended— 
(i) in subparagraph (B)(i) by insert-
ing ‘‘or, in the case of an individual en-
rolled in such an employee welfare benefit 
plan pursuant to a COBRA continuation 
provision (as defined in section 2791(d)(4) 
of the Public Health Service Act), that the 
individual disenrolls from such plan and 
enrolls under part B’’ before the period at 
the end; and 
(ii) in subparagraph (E), as amended 
by paragraph (1), by adding at the end the 
following new clause: 
‘‘(viii) in the case of an individual described in 
subparagraph (B)(i) who enrolled in an employee 
welfare benefit plan described in such subparagraph 
pursuant to a COBRA continuation provision (as de-
fined in section 2791(d)(4) of the Public Health 
Service Act) and who disenrolls from such plan and 
enrolls under part B, the period beginning on 60 
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days before the effective date of such disenrollment 
and ending on the date that is 63 days after such 
effective date.’’. 
(B) 
TECHNICAL
CORRECTION.—Section 
1882(s)(2)(D) of the Social Security Act (42 
U.S.C. 1395ss(s)(2)(D)) is amended— 
(i) by striking ‘‘2701(c)’’ and insert-
ing ‘‘2704(c)’’; and 
(ii) by striking ‘‘2701(a)(3)’’ and in-
serting ‘‘2704(a)(3)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraphs (1) and (2)(A) shall apply to medi-
care supplemental policies effective on or after Janu-
ary 1, 2020. 
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’’; 
(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— 
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‘‘(i) with respect to periods beginning be-
fore January 1, 2020, 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 
‘‘(ii) with respect to periods beginning on 
or after January 1, 2020, 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.— 
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‘‘(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 
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; 
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‘‘(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-
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, 2020.’’. 
(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)’’. 
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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 
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 
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‘‘(C) during the period prior to January 1, 
2023, 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 
Medigap Consumer Protection Act of 2016 and, 
in the case that a State has no such rules per-
taining to guaranteed issue of such policies, 
clear language explaining the implications of 
such lack of rules for individuals with pre-exist-
ing conditions; 
‘‘(2) not later than January 1, 2018, 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-
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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 
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 
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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 
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 
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‘‘(3) provide a 60-day public comment period 
with respect to such information.’’. 
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 CONFLICTS OF INTEREST. 
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 
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such policy. Each such report shall include the fol-
lowing information, with respect to such a payment 
or other transfer of value: 
‘‘(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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