Title: Medigap Consumer Protection Act of 2019
Policy area: Health

Summary:
Medigap Consumer Protection Act of 2019
This bill modifies several provisions with respect to Medigap policies (Medicare supplemental health insurance policies) and other requirements under Medicare.
Among other things, the bill (1) expands guaranteed issue rights with respect to Medigap policies, which require that a policy be offered to any eligible applicant without regard to health status; and (2) establishes an annual cost-sharing limit under Medicare of $5,500 beginning in 2022, with annual adjustments thereafter.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2428 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 2428

To amend title XVIII of the Social Security Act to provide for certain 
    reforms with respect to Medicare supplemental health insurance 
                   policies, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 1, 2019

  Mr. Brown (for himself and Ms. Klobuchar) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for certain 
    reforms with respect to Medicare supplemental health insurance 
                   policies, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medigap Consumer 
Protection Act of 2019''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Guaranteed issue.
Sec. 3. Limitations on pricing discrimination.
Sec. 4. Clarification regarding standardized Medigap plans.
Sec. 5. Improving information available to Medicare beneficiaries.
Sec. 6. Broker conflicts of interest.
Sec. 7. Protecting against high out-of-pocket expenditures for Medicare 
                            fee-for-service benefits.
Sec. 8. Study and report on variations among Medigap plans.

SEC. 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)) is amended--
                    (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 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''; 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 of Health and Human Services 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 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)).
    (b) Guaranteed Issue of Medigap Policies for Medicare Advantage and 
Medicaid Enrollees, Certain Veterans, and Other Individuals Determined 
Appropriate by the Secretary; Treatment of Individuals With COBRA.--
            (1) In general.--Section 1882(s)(3) of the Social Security 
        Act (42 U.S.C. 1395ss(s)(3)) is 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
                    ``(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 medical 
                        or other remedial care and was enrolled in such 
                        plan or waiver; or
                            ``(bb) was otherwise eligible for medical 
                        assistance under a State plan or waiver under 
                        title XIX and subsequently lost eligibility for 
                        such medical assistance.
            ``(ix) The individual--
                    ``(I) is entitled to, or enrolled for, benefits 
                under part A and enrolled for benefits under part B;
                    ``(II) is a covered beneficiary (as that term is 
                defined in section 1072(5) of title 10, United States 
                Code), entitled to medical and dental care under 
                chapter 55 of that title, who was receiving medical 
                care at a facility of the uniformed services through 
                such entitlement; and
                    ``(III) no longer receives such care at such 
                facility because--
                            ``(aa) such facility has been closed;
                            ``(bb) such facility no longer offers such 
                        care;
                            ``(cc) the individual no longer meets the 
                        requirements for eligibility for such care; or
                            ``(dd) the individual moved away from the 
                        facility.
            ``(x) The individual meets such other requirements that the 
        Secretary, through notice and comment rulemaking, determines 
        appropriate.'';
                    (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), (viii), (ix), or 
        (x) 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 period 
                        at the end and inserting a semicolon; and
                            (iii) by adding at the end the following 
                        new clauses--
            ``(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;
            ``(vii) in the case of an individual described in 
        subparagraph (B)(viii) who is eligible for medical assistance 
        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 assistance 
        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 
        six months after the individual receives such notice;
            ``(ix) in the case of an individual described in 
        subparagraph (B)(ix), during the 63 days after the individual 
        is no longer eligible to receive the care from the facility 
        described in such subparagraph;
            ``(x) in the case of an individual described in 
        subparagraph (B)(x), such period as is specified by the 
        Secretary; and''.
            (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 inserting 
                        ``or, in the case of an individual enrolled 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 defined 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 the date that 
        is 60 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 inserting 
                        ``2704(c)''; and
                            (ii) by striking ``2701(a)(3)'' and 
                        inserting ``2704(a)(3)''.
            (3) Effective date.--The amendments made by paragraphs (1) 
        and (2)(A) shall apply to Medicare supplemental policies 
        effective on or after January 1, 2023.
    (c) MedPAC Studies and Reports.--
            (1) Annual open enrollment.--
                    (A) Study.--The Medicare Payment Advisory 
                Commission (in this section referred to as the 
                ``Commission'') shall conduct a study on providing an 
                open enrollment period for Medicare supplemental 
                policies (under section 1882 of the Social Security Act 
                (42 U.S.C. 1395ss)) under which an individual could 
                enroll in such a policy with guaranteed issue 
                protections. Such study shall include an analysis of--
                            (i) the impact of the ``birthday rule'' in 
                        California and Oregon, where an individual can 
                        enroll with such protections in a new policy 
                        with the same or lesser benefits within 30 days 
                        of their birthday;
                            (ii) the impact of such birthday rule if 
                        such rule permitted the individual to enroll 
                        with such protections in any policy; and
                            (iii) other areas determined appropriate by 
                        the Commission.
                    (B) Report.--Not later than 2 years after the date 
                of the enactment of this Act, the Commission shall 
                submit to Congress a report on the study conducted 
                under subparagraph (A), together with recommendations 
                for such legislation and administrative action as the 
                Commission determines appropriate.
            (2) Equitable relief.--
                    (A) Study.--The Medicare Payment Advisory 
                Commission (in this section referred to as the 
                ``Commission'') shall conduct a study on the Secretary 
                of Health and Human Services granting equitable relief 
                for enrollment in a Medicare supplemental policy (under 
                section 1882 of the Social Security Act (42 U.S.C. 
                1395ss)) in a similar manner as the Secretary grants 
                such relief for enrollment under part B of the Medicare 
                program.
                    (B) Report.--Not later than 2 years after the date 
                of the enactment of this Act, the Commission shall 
                submit to Congress a report on the study conducted 
                under subparagraph (A), together with recommendations 
                for such legislation and administrative action as the 
                Commission determines appropriate.
    (d) Outreach Plan.--
            (1) In general.--The Secretary of Health and Human Services 
        shall develop an outreach plan to notify individuals (including 
        individuals described in clause (viii) of section 1882(s)(3)(B) 
        of the Social Security Act (42 U.S.C. 1395ss(s)(3)(B)), as 
        added by subsection (b)(1)) that may be affected by the 
        provisions of, and amendments made by, this section regarding 
        such provisions and amendments.
            (2) Consultation.--In implementing the outreach plan 
        developed under paragraph (1), the Secretary of Health and 
        Human Services shall consult with consumer advocates, brokers, 
        insurers, the National Association of Insurance Commissioners, 
        and State Health Insurance Assistance Programs.

SEC. 3. LIMITATIONS ON PRICING DISCRIMINATION.

    (a) In General.--Section 1882 of the Social Security Act (42 U.S.C. 
1395ss) is 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 or health status 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 metropolitan statistical 
                area.
            ``(3) Application date.--The revised standards shall apply 
        to benefit packages sold, issued, or renewed under this section 
        to an individual who first become entitled to benefits under 
        part A or first enrolls in part B on or after January 1, 
        2023.''.
    (b) Conforming Amendment.--Section 1882(o)(1) of the Social 
Security Act (42 U.S.C. 1395ss(o)(1)) is amended by striking ``, and 
(y)'' and inserting ``(y), and (aa)''.

SEC. 4. CLARIFICATION REGARDING STANDARDIZED MEDIGAP PLANS.

    Section 1882 of the Social Security Act (42 U.S.C. 1395ss), as 
amended by section (3), is amended by adding at the end the following 
new subsection:
    ``(bb) Limitation on Additional Benefits.--A standard benefit 
package established under this section may not include benefits that 
are in addition to the standard benefits under the package. An issuer 
of a Medicare supplemental policy may offer such additional 
standardized benefits through a separate rider.''.

SEC. 5. IMPROVING INFORMATION AVAILABLE TO MEDICARE BENEFICIARIES.

    (a) 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:
    ``(e) 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) consult with at least one independent entity that 
        represents consumers in the development of such website;
            ``(2) 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 based on the individual's specific health status;
                    ``(C) during the period prior to January 1, 2023, 
                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 Medigap Consumer Protection Act 
                of 2019 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; and
                    ``(D) clear information on local resources for 
                individuals, such as information on their State Health 
                Insurance Assistance Program (SHIP);
            ``(3) not later than January 1, 2021, 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
            ``(4) not later than 12 months after the last day of each 
        period for the request for information under subsection (f), 
        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); 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.
    ``(f) 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).
    ``(g) 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 (e), 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.''.
    (b) Improved Information on Medigap.--As the Secretary of Health 
and Human Services works to update the materials provided to Medicare 
beneficiaries regarding the Medicare program and Medicare supplemental 
policies based on the provisions of, and amendments made by, this Act, 
the Secretary shall consult with at least one independent entity that 
represents consumers.
    (c) Equal Treatment Between Information on the Medicare Fee-for-
Service Program and the Medicare Advantage Program.--The Secretary of 
Health and Human Services shall ensure that--
            (1) any information distributed or otherwise made available 
        to the public and related to the Medicare program does not 
        display a bias towards the Medicare Advantage program over the 
        original Medicare fee-for-service program, or vice versa; and
            (2) the volume of such information is equally weighted 
        between such programs.

SEC. 6. 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 6 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.''.

SEC. 7. PROTECTING AGAINST HIGH OUT-OF-POCKET EXPENDITURES FOR MEDICARE 
              FEE-FOR-SERVICE BENEFITS.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

          ``protection against high out-of-pocket expenditures

    ``Sec. 1899C.  (a) In General.--Notwithstanding any other provision 
of this title, in the case of an individual entitled to, or enrolled 
for, benefits under part A or enrolled in part B, if the amount of the 
out-of-pocket cost-sharing of such individual for a year (beginning 
with 2022) equals or exceeds the annual out-of-pocket limit under 
subsection (b) for that year--
            ``(1) the amount otherwise payable under part A and the 
        total amount of expenses incurred by the individual which would 
        (except for this section) constitute incurred expenses for 
        which benefits are payable under part B, shall be 100 percent 
        of such amount for the remainder of that year; and
            ``(2) the individual shall not be responsible for out-of-
        pocket cost-sharing incurred during the remainder of that year.
    ``(b) Annual Out-of-Pocket Limit.--
            ``(1) In general.--The amount of the annual out-of-pocket 
        limit under this subsection shall be--
                    ``(A) for 2022, $5,500; or
                    ``(B) for a subsequent year, the amount specified 
                in this subsection for the preceding year increased or 
                decreased by the percentage change in the Consumer 
                Price Index for All Urban Consumers for the 12-month 
                period ending with June of such preceding year.
            ``(2) Rounding.--If any amount determined under paragraph 
        (1)(B) is not a multiple of $5, such amount shall be rounded to 
        the nearest multiple of $5.
    ``(c) Out-of-Pocket Cost-Sharing Defined.--
            ``(1) In general.--Subject to paragraphs (2) and (3), in 
        this section, the term `out-of-pocket cost-sharing' means, with 
        respect to an individual, the amount of the expenses incurred 
        by the individual that are attributable to--
                    ``(A) deductibles, coinsurance and copayments 
                applicable under part A or B; or
                    ``(B) for items and services that would have 
                otherwise been covered under part A or B but for the 
                exhaustion of those benefits.
            ``(2) Certain costs not included.--
                    ``(A) Non-covered items and services.--Expenses 
                incurred for items and services which are not covered 
                under part A or B shall not be considered incurred 
                expenses for purposes of determining out-of-pocket 
                cost-sharing under paragraph (1).
                    ``(B) Items and services not furnished on an 
                assignment-related basis.--If an item or service is 
                furnished to an individual under this title and is not 
                furnished on an assignment-related basis, any 
                additional expenses the individual incurs above the 
                amount the individual would have incurred if the item 
                or service was furnished on an assignment-related basis 
                shall not be considered incurred expenses for purposes 
                of determining out-of-pocket cost-sharing under 
                paragraph (1).
            ``(3) Source of payment.--For purposes of paragraph (1), 
        the Secretary shall consider expenses to be incurred by the 
        individual without regard to whether the individual or another 
        person, including a State program, an employer, a Medicare 
        supplemental policy, or other third-party coverage, has paid 
        for such expenses.
    ``(d) Announcement of the Annual Out-of-Pocket Limit.--The 
Secretary shall (beginning in 2021) announce (in a manner intended to 
provide notice to all interested parties) the annual out-of-pocket 
limit under this section that will be applicable for the succeeding 
year.''.

SEC. 8. STUDY AND REPORT ON VARIATIONS AMONG MEDIGAP PLANS.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the variations among Medicare supplemental policies under 
section 1882 of the Social Security Act (42 U.S.C. 1395ss). Such study 
shall include an analysis of the following:
            (1) How the variations among such policies impacts Medicare 
        beneficiaries' choices.
            (2) Ways to improve standardization and tools to help 
        Medicare beneficiaries make informed choices with respect to 
        such policies.
            (3) Other items determined appropriate by the Comptroller 
        General.
    (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Comptroller General shall submit to Congress a report 
on the study conducted under subsection (a), together with 
recommendations for such legislation and administrative action as the 
Comptroller General determines appropriate.
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