Medigap Consumer Protection Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 1394 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 FEBRUARY 27, 2019 Mr. DOGGETT introduced the following bill; which was referred to the Com- mittee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speak- er, in each case for consideration of such provisions as fall within the ju- risdiction 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medigap Consumer 4 Protection Act of 2019’’. 5 SEC. 2. GUARANTEED ISSUE. 6 (a) GUARANTEED ISSUE OF MEDIGAP POLICIES TO 7 ALL MEDIGAP-ELIGIBLE MEDICARE BENEFICIARIES.— 8 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 1394 IH (1) IN GENERAL.—Section 1882(s) of the So- 1 cial Security Act (42 U.S.C. 1395ss(s)) is amend- 2 ed— 3 (A) in paragraph (2)(A), by striking ‘‘65 4 years of age or older and is enrolled for benefits 5 under part B’’ and inserting ‘‘entitled to, or en- 6 rolled for, benefits under part A and enrolled 7 for benefits under part B’’; 8 (B) in paragraph (2)(D), by striking ‘‘who 9 is 65 years of age or older as of the date of 10 issuance and’’; 11 (C) in paragraph (3)(B)(ii), by striking ‘‘is 12 65 years of age or older and’’; and 13 (D) in paragraph (3)(B)(vi), by striking 14 ‘‘at age 65’’. 15 (2) EFFECTIVE DATE; PHASE-IN AUTHORITY.— 16 (A) EFFECTIVE DATE.—Subject to sub- 17 paragraph (B), the amendments made by para- 18 graph (1) shall apply to medicare supplemental 19 policies effective on or after January 1, 2022. 20 (B) PHASE-IN AUTHORITY.— 21 (i) IN GENERAL.—Subject to clause 22 (ii), the Secretary of Health and Human 23 Services may phase in the implementation 24 of the amendments made under paragraph 25 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 1394 IH (1) (with such phase-in beginning on or 1 after January 1, 2022) in such manner as 2 the Secretary determines appropriate in 3 order to minimize any adverse impact on 4 individuals enrolled under a medicare sup- 5 plemental policy. 6 (ii) PHASE-IN PERIOD MAY NOT EX- 7 CEED 5 YEARS.—The Secretary of Health 8 and Human Services shall ensure that the 9 amendments made by paragraph (1) are 10 fully implemented by not later than Janu- 11 ary 1, 2027. 12 (3) ADDITIONAL ENROLLMENT PERIOD FOR 13 CERTAIN INDIVIDUALS.— 14 (A) ONE-TIME ENROLLMENT PERIOD.— 15 (i) IN GENERAL.—In the case of an 16 individual described in subparagraph (B), 17 the Secretary shall establish a one-time en- 18 rollment period during which such an indi- 19 vidual may enroll in any medicare supple- 20 mental policy of the individual’s choosing. 21 (ii) PERIOD.—The enrollment period 22 established under clause (i) shall begin on 23 the date on which the phase-in period 24 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 1394 IH under paragraph (2) is completed and end 1 6 months after such date. 2 (B) INDIVIDUAL DESCRIBED.—An indi- 3 vidual described in this paragraph is an indi- 4 vidual who— 5 (i) is entitled to hospital insurance 6 benefits under part A under section 226(b) 7 or section 226A of the Social Security Act 8 (42 U.S.C. 426(b); 426–1); 9 (ii) is enrolled for benefits under part 10 B of such Act (42 U.S.C. 1395j et seq.); 11 and 12 (iii) would not, but for the provisions 13 of and amendments made by paragraphs 14 (1) and (2), be eligible for the guaranteed 15 issue of a medicare supplemental policy 16 under paragraph (2) or (3) of section 17 1882(s) of such Act (42 U.S.C. 1395ss(s)). 18 (C) OUTREACH PLAN.— 19 (i) IN GENERAL.—The Secretary shall 20 develop an outreach plan to notify individ- 21 uals described in subparagraph (B) of the 22 one-time enrollment period established 23 under subparagraph (A). 24 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 1394 IH (ii) CONSULTATION.—In imple- 1 menting the outreach plan developed under 2 clause (i), the Secretary shall consult with 3 consumer advocates, brokers, insurers, the 4 National Association of Insurance Commis- 5 sioners, and State Health Insurance As- 6 sistance Programs. 7 (b) GUARANTEED ISSUE OF MEDIGAP POLICIES FOR 8 MEDICARE ADVANTAGE AND MEDICAID ENROLLEES; 9 TREATMENT OF INDIVIDUALS WITH COBRA.— 10 (1) IN GENERAL.—Section 1882(s)(3) of the 11 Social Security Act (42 U.S.C. 1395ss(s)(3)), as 12 amended by subsection (a), is further amended— 13 (A) in subparagraph (B), by adding at the 14 end the following new clauses: 15 ‘‘(vii) The individual was enrolled in a Medicare 16 Advantage plan under part C for not less than 12 17 months and subsequently disenrolled from such plan 18 and elects to receive benefits under this title through 19 the original Medicare fee-for-service program under 20 parts A and B. 21 ‘‘(viii) The individual— 22 ‘‘(I) is entitled to, or enrolled for, benefits 23 under part A and enrolled for benefits under 24 part B; and 25 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 1394 IH ‘‘(II) either— 1 ‘‘(aa) is eligible for medical assistance 2 under a State plan or waiver under title 3 XIX based on a reduction of income of the 4 individual based on costs incurred for med- 5 ical or other remedial care and was en- 6 rolled in such plan or waiver; or 7 ‘‘(bb) was otherwise eligible for med- 8 ical assistance under a State plan or waiv- 9 er under title XIX and subsequently lost 10 eligibility for such medical assistance.’’; 11 (B) by striking subparagraph (C)(iii) and 12 inserting the following: 13 ‘‘(iii) Subject to subsection (v)(1), for purposes 14 of an individual described in clause (vi), (vii), or 15 (viii) of subparagraph (B), a medicare supplemental 16 policy described in this subparagraph shall include 17 any medicare supplemental policy.’’; and 18 (C) in subparagraph (E)— 19 (i) in clause (iv), by striking ‘‘and’’ at 20 the end; 21 (ii) in clause (v), by striking the pe- 22 riod at the end and inserting a semicolon; 23 and 24 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 1394 IH (iii) by adding at the end the fol- 1 lowing new clauses— 2 ‘‘(vi) in the case of an individual described in 3 subparagraph (B)(vii), the annual, coordinated elec- 4 tion period (as defined in section 1851(e)(3)(B)) or 5 a continuous open enrollment period (as defined in 6 section 1851(e)(2)) during which the individual 7 disenrolls from a Medicare Advantage plan under 8 part C; 9 ‘‘(vii) in the case of an individual described in 10 subparagraph (B)(viii) who is eligible for medical as- 11 sistance under a State plan or waiver under title 12 XIX for a reason described in item (aa), such period 13 as is specified by the Secretary; 14 ‘‘(viii) in the case of an individual described in 15 subparagraph (B)(viii) who is eligible for medical as- 16 sistance under a State plan or waiver under title 17 XIX for a reason described in item (bb), the period 18 beginning on the date that the individual receives a 19 notice of cessation of such individual’s eligibility for 20 medical assistance under the State plan or waiver 21 under title XIX and ending on the date that is four 22 months after the individual receives such notice; 23 and’’. 24 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 1394 IH (2) TREATMENT OF INDIVIDUALS WITH 1 COBRA.— 2 (A) IN GENERAL.—Section 1882(s)(3) of 3 the Social Security Act (42 U.S.C. 4 1395ss(s)(3)), as amended by subsection (a) 5 and paragraph (1), is further amended— 6 (i) in subparagraph (B)(i) by insert- 7 ing ‘‘or, in the case of an individual en- 8 rolled in such an employee welfare benefit 9 plan pursuant to a COBRA continuation 10 provision (as defined in section 2791(d)(4) 11 of the Public Health Service Act), that the 12 individual disenrolls from such plan and 13 enrolls under part B’’ before the period at 14 the end; and 15 (ii) in subparagraph (E), as amended 16 by paragraph (1), by adding at the end the 17 following new clause: 18 ‘‘(ix) in the case of an individual described in 19 subparagraph (B)(i) who enrolled in an employee 20 welfare benefit plan described in such subparagraph 21 pursuant to a COBRA continuation provision (as de- 22 fined in section 2791(d)(4) of the Public Health 23 Service Act) and who disenrolls from such plan and 24 enrolls under part B, the period beginning on 60 25 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 1394 IH days before the effective date of such disenrollment 1 and ending on the date that is 63 days after such 2 effective date.’’. 3 (B) TECHNICAL CORRECTION.—Section 4 1882(s)(2)(D) of the Social Security Act (42 5 U.S.C. 1395ss(s)(2)(D)) is amended— 6 (i) by striking ‘‘2701(c)’’ and insert- 7 ing ‘‘2704(c)’’; and 8 (ii) by striking ‘‘2701(a)(3)’’ and in- 9 serting ‘‘2704(a)(3)’’. 10 (3) EFFECTIVE DATE.—The amendments made 11 by paragraphs (1) and (2)(A) shall apply to medi- 12 care supplemental policies effective on or after Janu- 13 ary 1, 2022. 14 SEC. 3. MEDICAL LOSS RATIO. 15 Section 1882(r)(1)(A) of the Social Security Act (42 16 U.S.C. 1395ss(r)(1)(A)) is amended— 17 (1) by inserting ‘‘and periodically reviewed’’ 18 after ‘‘developed’’; and 19 (2) by striking ‘‘policy, at least 75 percent of 20 the aggregate amount of premiums collected in the 21 case of group policies and at least 65 percent in the 22 case of individual policies; and’’ and inserting the 23 following: ‘‘policy— 24 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 1394 IH ‘‘(i) with respect to periods beginning be- 1 fore January 1, 2022, at least 75 percent of the 2 aggregate amount of premiums collected in the 3 case of group policies and at least 65 percent 4 in the case of individual policies; and 5 ‘‘(ii) with respect to periods beginning on 6 or after January 1, 2022, a percent of the ag- 7 gregate amount of premiums collected that, in 8 the case of group policies or individual policies, 9 as applicable, is equal to or greater than both— 10 ‘‘(I) the applicable percent specified in 11 clause (i) with respect to such policies; and 12 ‘‘(II) such percent as the National As- 13 sociation of Insurance Commissioners may 14 recommend to the Secretary with respect 15 to such policies for purposes of this para- 16 graph; and’’. 17 SEC. 4. LIMITATIONS ON PRICING DISCRIMINATION. 18 (a) IN GENERAL.—Section 1882 of the Social Secu- 19 rity Act (42 U.S.C. 1395ss), as amended by section 6, is 20 further amended by adding at the end the following new 21 subsection: 22 ‘‘(aa) DEVELOPMENT OF NEW STANDARDS RELAT- 23 ING TO PRICING DISCRIMINATION.— 24 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 1394 IH ‘‘(1) IN GENERAL.—The Secretary shall request 1 the National Association of Insurance Commis- 2 sioners to review and revise the standards for all 3 benefit packages under subsection (p)(1), including 4 the core benefit package, in order to provide cov- 5 erage consistent with paragraph (2). Such revisions 6 shall be made consistent with the rules applicable 7 under subsection (p)(1)(E) (with the reference to the 8 ‘1991 NAIC Model Regulation’ deemed a reference 9 to the NAIC Model Regulation as most recently up- 10 dated by the National Association of Insurance 11 Commissioners to reflect previous changes in law 12 and the reference to ‘date of enactment of this sub- 13 section’ deemed a reference to the date of enactment 14 of this subsection). 15 ‘‘(2) CHANGES IN COST-SHARING DESCRIBED.— 16 Under the revised standards, coverage shall not be 17 available under a Medicare supplemental insurance 18 policy unless the issuer of the policy, in addition to 19 conforming to the other applicable requirements of 20 this section— 21 ‘‘(A) does not discriminate in the pricing 22 of the policy because of the age of the indi- 23 vidual to whom the policy is issued; 24 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 12 •HR 1394 IH ‘‘(B) does not, to an extent that jeopard- 1 izes the access to such policy for individuals 2 who are eligible to participate in the program 3 under this title because the individuals are indi- 4 viduals described in paragraph (2) or (3) of sec- 5 tion 1811, discriminate in the pricing of the 6 policy because the individual to whom the policy 7 is issued is so eligible to participate in such 8 program because the individual is an individual 9 so described in such a paragraph; and 10 ‘‘(C) does not establish premiums applica- 11 ble under such policy on a basis that would 12 apply to a portion of, but not the entirety of, 13 a county or equivalent area specified by the 14 Secretary. 15 ‘‘(3) APPLICATION DATE.—The revised stand- 16 ards shall apply to benefit packages sold, issued, or 17 renewed under this section to individuals who first 18 become entitled to benefits under part A or first en- 19 rolls in part B on or after January 1, 2022.’’. 20 (b) CONFORMING AMENDMENT.—Section 1882(o)(1) 21 of such Act (42 U.S.C. 1395ss(o)(1)) is amended by strik- 22 ing ‘‘, and (y)’’ and inserting ‘‘(y), and (aa)’’. 23 VerDate Sep 11 2014 00:32 Mar 08, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394 pamtmann on DSKBFK8HB2PROD with BILLS 13 •HR 1394 IH SEC. 5. CLARIFYING BENEFICIARY OPTIONS ON THE MEDI- 1 CARE PLAN FINDER WEBSITE. 2 Section 1804 of the Social Security Act (42 U.S.C. 3 1395b–2) is amended by adding at the end the following [Text truncated for display. Full text available on Congress.gov.]