Close the Medigap Act of 2021
Bill: H.R.4640 | Sponsor: Rep. Doggett, Lloyd (D-TX)
Policy area: Health

Summary:
Close the Medigap Act of 2021
This bill (1) expands guaranteed issue rights with respect to Medigap policies (Medicare supplemental health insurance policies), (2) eliminates certain limitations on Medigap policies for newly eligible Medicare beneficiaries, and (3) modifies other provisions related to Medigap policies. (Guaranteed issue rights require that a policy be offered to any eligible applicant without regard to health status.)

To amend title XVIII of the Social Security Act to provide for certain 
    reforms with respect to medicare supplemental health insurance 
                               policies.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

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 Security 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 effectiveness of a 
        medicare supplemental policy, or discriminate 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 preexisting 
        conditions, waiting periods, elimination periods, and 
        probationary periods for any benefit;
            ``(D) deny or condition the issuance or effectiveness of 
        the policy (including the imposition of any exclusion of 
        benefits under the policy based on a preexisting condition) or 
        discriminate in the pricing of the policy (including the 
        adjustment of premium rates) of an individual on the basis of 
        the genetic information with respect to such individual;
            ``(E) deny or condition the issuance or effectiveness of a 
        medicare supplemental policy that is offered 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 effectiveness 
        of the policy or increasing the premium for an employer based 
        on the manifestation of a disease 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 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 outreach plan 
        developed under paragraph (1), the Secretary shall consult with 
        consumer advocates, brokers, insurers, the National Association 
        of Insurance Commissioners, and State Health Insurance 
        Assistance 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 subparagraph (B), the 
                Secretary of Health and Human Services may phase in the 
                implementation of the amendment made under subsection 
                (a) (with such phase-in beginning on or after January 
                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 before 
                January 1, 2022, 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, 2022, a percent of the aggregate 
                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 
                        Association of Insurance Commissioners may 
                        recommend to the Secretary with respect to such 
                        policies for purposes of this paragraph; and''.

SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION.

    (a) In General.--Section 1882 of the Social Security 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 Relating to Pricing 
Discrimination.--
            ``(1) In general.--The Secretary shall request the National 
        Association of Insurance Commissioners to review and revise the 
        standards for all benefit packages under subsection (p)(1), 
        including the core benefit package, in order to provide 
        coverage 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 updated by the National Association of Insurance 
        Commissioners to reflect previous changes in law and the 
        reference to `date of enactment of this subsection' 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 individual to whom the 
                policy is issued;
                    ``(B) does not, to an extent that jeopardizes the 
                access to such policy for individuals who are eligible 
                to participate in the program under this title because 
                the individuals are individuals described in paragraph 
                (2) or (3) of section 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 applicable 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 standards 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 enrolls 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 striking ``, and (y)'' and inserting 
``(y), and (aa)''.

SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDICARE 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 accordance 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 information 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 expenditures, 
                including deductibles, copayments, coinsurance, monthly 
                premiums, and estimated annual out-of-pocket costs, 
                displayed overall and by components, based on the best 
                available information 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 medicare supplemental 
                health insurance policies prior to implementation of 
                the provisions of the Close the Medigap Act of 2021 
                and, in the case that a State has no such rules 
                pertaining to guaranteed issue of such policies, clear 
                language explaining the implications of such lack of 
                rules for individuals with pre-existing conditions;
            ``(2) not later than January 1, 2020, and periodically 
        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 Secretary 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 consumer options for medicare supplemental 
        health insurance 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 information 
                regarding the applicable premiums under such policy 
                options as of the date on which such website is so 
                updated;
                    ``(B) facilitates consumers' ability to compare and 
                sort policy options and premium information across plan 
                offerings in a given location;
                    ``(C) clarifies and explains differences in policy 
                value;
                    ``(D) rates and explains the financial stability 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 Human Services shall provide an opportunity 
for public comment during which the Secretary requests information, 
including recommendations, from stakeholders regarding 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 Secretary makes 
available on the Medicare plan finder internet website of the Centers 
for Medicare & Medicaid Services (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 opportunity 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.''.

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 enactment of such subsection),''; and
            (2) by adding at the end the following new subsection:
    ``(f) Application to Medigap Insurance Brokers.--
            ``(1) In general.--Beginning not later than 12 months after 
        the date of enactment of this subsection, 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 following information, with 
        respect to such a payment or other transfer of value:
                    ``(A) The name of the recipient of the payment 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 payment or 
                transfer of value.
                    ``(F) Any other categories of information the 
                Secretary determines appropriate.
            ``(2) Application of transparency system.--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 
        parties 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 recipient.''.
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