Protecting Medicare Beneficiaries with Pre-Existing Conditions Act

I 116TH CONGRESS 1ST SESSION H. R. 4676 To amend title XVIII of the Social Security Act to provide for the guaranteed issue of Medigap policies to all Medigap-eligible Medicare beneficiaries and Medicare Advantage enrollees, and for other purposes. IN THE HOUSE OF REPRESENTATIVES OCTOBER 15, 2019 Mr. SCHNEIDER 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 the guaranteed issue of Medigap policies to all Medigap-eligible Medicare beneficiaries and Medicare Ad- vantage enrollees, and for other purposes. 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 ‘‘Protecting Medicare 4 Beneficiaries with Pre-Existing Conditions Act’’. 5 VerDate Sep 11 2014 01:25 Oct 17, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4676.IH H4676 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4676 IH SEC. 2. GUARANTEED ISSUE. 1 (a) GUARANTEED ISSUE OF MEDIGAP POLICIES TO 2 ALL MEDIGAP-ELIGIBLE MEDICARE BENEFICIARIES.— 3 (1) IN GENERAL.—Section 1882(s) of the So- 4 cial Security Act (42 U.S.C. 1395ss(s)) is amend- 5 ed— 6 (A) in paragraph (2)(A), by striking ‘‘65 7 years of age or older and is enrolled for benefits 8 under part B’’ and inserting ‘‘entitled to, or en- 9 rolled for, benefits under part A and enrolled 10 for benefits under part B’’; 11 (B) in paragraph (2)(D), by striking ‘‘who 12 is 65 years of age or older as of the date of 13 issuance and’’; 14 (C) in paragraph (3)(B)(ii), by striking ‘‘is 15 65 years of age or older and’’; and 16 (D) in paragraph (3)(B)(vi), by striking 17 ‘‘at age 65’’. 18 (2) EFFECTIVE DATE; PHASE-IN AUTHORITY.— 19 (A) EFFECTIVE DATE.—Subject to sub- 20 paragraph (B), the amendments made by para- 21 graph (1) shall apply to medicare supplemental 22 policies effective on or after January 1, 2023. 23 (B) PHASE-IN AUTHORITY.— 24 (i) IN GENERAL.—Subject to clause 25 (ii), the Secretary of Health and Human 26 VerDate Sep 11 2014 01:25 Oct 17, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4676.IH H4676 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4676 IH Services may phase in the implementation 1 of the amendments made under paragraph 2 (1) (with such phase-in beginning on or 3 after January 1, 2023) in such manner as 4 the Secretary determines appropriate in 5 order to minimize any adverse impact on 6 individuals enrolled under a medicare sup- 7 plemental policy. 8 (ii) PHASE-IN PERIOD MAY NOT EX- 9 CEED 5 YEARS.—The Secretary of Health 10 and Human Services shall ensure that the 11 amendments made by paragraph (1) are 12 fully implemented by not later than Janu- 13 ary 1, 2028. 14 (3) ADDITIONAL ENROLLMENT PERIOD FOR 15 CERTAIN INDIVIDUALS.— 16 (A) ONE-TIME ENROLLMENT PERIOD.— 17 (i) IN GENERAL.—In the case of an 18 individual described in subparagraph (B), 19 the Secretary shall establish a one-time en- 20 rollment period during which such an indi- 21 vidual may enroll in any medicare supple- 22 mental policy of the individual’s choosing. 23 (ii) PERIOD.—The enrollment period 24 established under clause (i) shall begin on 25 VerDate Sep 11 2014 01:25 Oct 17, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4676.IH H4676 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4676 IH the date on which the phase-in period 1 under paragraph (2) is completed and end 2 6 months after such date. 3 (B) INDIVIDUAL DESCRIBED.—An indi- 4 vidual described in this paragraph is an indi- 5 vidual who— 6 (i) is entitled to hospital insurance 7 benefits under part A of title XVIII of the 8 Social Security Act (42 U.S.C. 1395c et 9 seq.) pursuant to section 226(b) or section 10 226A of such Act (42 U.S.C. 426(b); 426– 11 1); 12 (ii) is enrolled for benefits under part 13 B of such Act (42 U.S.C. 1395j et seq.); 14 and 15 (iii) would not, but for the provisions 16 of and amendments made by paragraphs 17 (1) and (2), be eligible for the guaranteed 18 issue of a medicare supplemental policy 19 under paragraph (2) or (3) of section 20 1882(s) of such Act (42 U.S.C. 1395ss(s)). 21 (C) OUTREACH PLAN.— 22 (i) IN GENERAL.—The Secretary shall 23 develop an outreach plan to notify individ- 24 uals described in subparagraph (B) of the 25 VerDate Sep 11 2014 01:25 Oct 17, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4676.IH H4676 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4676 IH one-time enrollment period established 1 under subparagraph (A). 2 (ii) CONSULTATION.—In imple- 3 menting the outreach plan developed under 4 clause (i), the Secretary shall consult with 5 consumer advocates, brokers, insurers, the 6 National Association of Insurance Commis- 7 sioners, and State Health Insurance As- 8 sistance Programs. 9 (b) GUARANTEED ISSUE OF MEDIGAP POLICIES FOR 10 MEDICARE ADVANTAGE ENROLLEES.— 11 (1) IN GENERAL.—Section 1882(s)(3) of the 12 Social Security Act (42 U.S.C. 1395ss(s)(3)), as 13 amended by subsection (a), is further amended— 14 (A) in subparagraph (B), by adding at the 15 end the following new clause: 16 ‘‘(vii) The individual was enrolled in a Medicare 17 Advantage plan under part C for not less than 12 18 months and subsequently disenrolled from such plan 19 and elects to receive benefits under this title through 20 the original Medicare fee-for-service program under 21 parts A and B.’’; 22 (B) by striking subparagraph (C)(iii) and 23 inserting the following: 24 VerDate Sep 11 2014 01:25 Oct 17, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4676.IH H4676 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4676 IH ‘‘(iii) Subject to subsection (v)(1), for purposes of an 1 individual described in clause (vi) or (vii) of subparagraph 2 (B), a medicare supplemental policy described in this sub- 3 paragraph shall include any medicare supplemental pol- 4 icy.’’; and 5 (C) in subparagraph (E)— 6 (i) in clause (iv), by striking ‘‘and’’ at 7 the end; 8 (ii) in clause (v), by striking the pe- 9 riod at the end and inserting ‘‘; and’’; and 10 (iii) by adding at the end the fol- 11 lowing new clause— 12 ‘‘(vi) in the case of an individual described in 13 subparagraph (B)(vii), the annual, coordinated elec- 14 tion period (as defined in section 1851(e)(3)(B)) or 15 a continuous open enrollment period (as defined in 16 section 1851(e)(2)) during which the individual 17 disenrolls from a Medicare Advantage plan under 18 part C.’’. 19 (2) EFFECTIVE DATE.—The amendments made 20 by paragraph (1) shall apply to medicare supple- 21 mental policies effective on or after January 1, 22 2023. 23 Æ VerDate Sep 11 2014 01:25 Oct 17, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H4676.IH H4676 pamtmann on DSKBC07HB2PROD with BILLS