,,ii #aafth ,,congress #ast ,session ,s4 #bdbh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #a1 #bjai,mr4 ,brown 7for himself and ,ms4 ,klobuchar7 introduced the following bill2 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 policies1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,medigap ,consumer ,protection ,act of #bjai4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,guaranteed issue4 ,sec4 #c4 ,limitations on pricing discrimination4 ,sec4 #d4 ,clarification regarding standardized ,medigap plans4 ,sec4 #e4 ,improving information available to ,medicare beneficiaries4 ,sec4 #f4 ,broker conflicts of interest4 ,sec4 #g4 ,protecting against high out-of-pocket expenditures for ,medicare fee-for-service benefits4 ,sec4 #h4 ,study and report on variations among ,medigap plans4 #b4 ,guaranteed issue 7a7 ,guaranteed issue of ,medigap policies to all ,medigap-,eligible ,medicare beneficiaries 7#a7 ,in general ,section #ahhb7s7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77 is amended-- 7,a7 in paragraph 7#b77;,a71 by striking #fe years of age or older and is enrolled for benefits under part ,b and inserting entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 7,b7 in paragraph 7#b77;,d71 by striking who is #fe years of age or older as of the date of issuance and2 7,c7 in paragraph 7#c77;,b77ii71 by striking is #fe years of age or older and2 and 7,d7 in paragraph 7#c77;,b77vi71 by striking at age #fe4 7#b7 ,effective date2 phase-,in authority 7,a7 ,effective date ,subject to subparagraph 7,b71 the amendments made by paragraph 7#a7 shall apply to ,medicare supplemental policies effective on or after ,january #a1 #bjbc4 7,b7 ,phase-,in authority 7i7 ,in general ,subject to clause 7ii71 the ,secretary of ,health and ,human ,services may phase-in the implementation of the amendments made under paragraph 7#a7 7with such phase-in beginning on or after ,january #a1 #bjbc7 in such manner as the ,secretary determines appropriate in order to minimize any adverse impact on individuals enrolled under a ,medicare supplemental policy4 7ii7 ,phase-,in period may not exceed #e years ,the ,secretary of ,health and ,human ,services shall ensure that the amendments made by paragraph 7#a7 are fully implemented by not later than ,january #a1 #bjbh4 7#c7 ,additional enrollment period for certain individuals 7,a7 ,one-time enrollment period 7i7 ,in general ,in the case of an individual described in subparagraph 7,b71 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 choosing4 7ii7 ,period ,the enrollment period established under clause 7i7 shall begin on the date on which the phase-in period under paragraph 7#b7 is completed and end #f months after such date4 7,b7 ,individual described ,an individual described in this paragraph is an individual who-- 7i7 is entitled to hospital insurance benefits under part ,a under section #bbf7;b7 or section #bbf;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7;b72 #dbf-a72 7ii7 is enrolled for benefits under part ,b of such ,act 7#db ,u4,s4,c4 #acie;j et seq472 and 7iii7 would not1 but for the provisions of and amendments made by paragraphs 7#a7 and 7#b71 be eligible for the guaranteed issue of a ,medicare supplemental policy under paragraph 7#b7 or 7#c7 of section #ahhb7s7 of such ,act 7#db ,u4,s4,c4 #aciess7s774 7b7 ,guaranteed issue of ,medigap policies for ,medicare ,advantage and ,medicaid enrollees1 certain veterans1 and other individuals determined appropriate by the ,secretary2 ,treatment of individuals with ,,cobra 7#a7 ,in general ,section #ahhb7s77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c77 is amended-- 7,a7 in subparagraph 7,b71 by adding at the end the following new clauses3 7vii7 ,the individual was enrolled in a ,medicare ,advantage plan under part ,c for not less than #ab 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 ,b4 7viii7 ,the individual-- 7,i7 is entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 and 7,,ii7 either-- 7aa7 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 waiver2 or 7bb7 was otherwise eligible for medical assistance under a ,state plan or waiver under title ,,xix and subsequently lost eligibility for such medical assistance4 7ix7 ,the individual-- 7,i7 is entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 7,,ii7 is a covered beneficiary 7as that term is defined in section #ajgb7e7 of title #aj1 ,united ,states ,code71 entitled to medical and dental care under chapter #ee of that title1 who was receiving medical care at a facility of the uniformed services through such entitlement2 and 7,,iii7 no longer receives such care at such facility because-- 7aa7 such facility has been closed2 7bb7 such facility no longer offers such care2 7cc7 the individual no longer meets the requirements for eligibility for such care2 or 7dd7 the individual moved away from the facility4 7x7 ,the individual meets such other requirements that the ,secretary1 through notice and comment rulemaking1 determines appropriate4 2 7,b7 by striking subparagraph 7,c77iii7 and inserting the following3 7iii7 ,subject to subsection 7v77#a71 for purposes of an individual described in clause 7vi71 7vii71 7viii71 7ix71 or 7x7 of subparagraph 7,b71 a ,medicare supplemental policy described in this subparagraph shall include any ,medicare supplemental policy4 2 and 7,c7 in subparagraph 7,e7-- 7i7 in clause 7iv71 by striking and at the end2 7ii7 in clause 7v71 by striking the period at the end and inserting a semicolon2 and 7iii7 by adding at the end the following new clauses-- 7vi7 in the case of an individual described in subparagraph 7,b77vii71 the annual1 coordinated election period 7as defined in section #ahea7;e77#c77;,b77 or a continuous open enrollment period 7as defined in section #ahea7;e77#b77 during which the individual disenrolls from a ,medicare ,advantage plan under part ,c2 7vii7 in the case of an individual described in subparagraph 7,b77viii7 who is eligible for medical assistance under a ,state plan or waiver under title ,,xix for a reason described in item 7aa71 such period as is specified by the ,secretary2 7viii7 in the case of an individual described in subparagraph 7,b77viii7 who is eligible for medical assistance under a ,state plan or waiver under title ,,xix for a reason described in item 7bb71 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 notice2 7ix7 in the case of an individual described in subparagraph 7,b77ix71 during the #fc days after the individual is no longer eligible to receive the care from the facility described in such subparagraph2 7x7 in the case of an individual described in subparagraph 7,b77x71 such period as is specified by the ,secretary2 and 4 7#b7 ,treatment of individuals with ,,cobra 7,a7 ,in general ,section #ahhb7s77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c771 as amended by subsection 7a7 and paragraph 7#a71 is further amended-- 7i7 in subparagraph 7,b77i7 by inserting or1 in the case of an individual enrolled in such an employee welfare benefit plan pursuant to a ,,cobra continuation provision 7as defined in section #bgia7;d77#d7 of the ,public ,health ,service ,act71 that the individual disenrolls from such plan and enrolls under part ,b before the period at the end2 and 7ii7 in subparagraph 7,e71 as amended by paragraph 7#a71 by adding at the end the following new clause3 7viii7 in the case of an individual described in subparagraph 7,b77i7 who enrolled in an employee welfare benefit plan described in such subparagraph pursuant to a ,,cobra continuation provision 7as defined in section #bgia7;d77#d7 of the ,public ,health ,service ,act7 and who disenrolls from such plan and enrolls under part ,b1 the period beginning on the date that is #fj days before the effective date of such disenrollment and ending on the date that is #fc days after such effective date4 4 7,b7 ,technical correction ,section #ahhb7s77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#b77;,d77 is amended-- 7i7 by striking #bgja7;c7 and inserting #bgjd7;c72 and 7ii7 by striking #bgja7;a77#c7 and inserting #bgjd7;a77#c74 7#c7 ,effective date ,the amendments made by paragraphs 7#a7 and 7#b77;,a7 shall apply to ,medicare supplemental policies effective on or after ,january #a1 #bjbc4 7c7 ,med,p,a,c studies and reports 7#a7 ,annual open enrollment 7,a7 ,study ,the ,medicare ,payment ,advisory ,commission 7in this section referred to as the ,commission7 shall conduct a study on providing an open enrollment period for ,medicare supplemental policies 7under section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess77 under which an individual could enroll in such a policy with guaranteed issue protections4 ,such study shall include an analysis of-- 7i7 the impact of the birthday rule in ,california and ,oregon1 where an individual can enroll with such protections in a new policy with the same or lesser benefits within #cj days of their birthday2 7ii7 the impact of such birthday rule if such rule permitted the individual to enroll with such protections in any policy2 and 7iii7 other areas determined appropriate by the ,commission4 7,b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,commission shall submit to ,congress a report on the study conducted under subparagraph 7,a71 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 7#b7 ,equitable relief 7,a7 ,study ,the ,medicare ,payment ,advisory ,commission 7in this section referred to as the ,commission7 shall conduct a study on the ,secretary of ,health and ,human ,services granting equitable relief for enrollment in a ,medicare supplemental policy 7under section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess77 in a similar manner as the ,secretary grants such relief for enrollment under part ,b of the ,medicare program4 7,b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,commission shall submit to ,congress a report on the study conducted under subparagraph 7,a71 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 7d7 ,outreach plan 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall develop an outreach plan to notify individuals 7including individuals described in clause 7viii7 of section #ahhb7s77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c77;,b771 as added by subsection 7b77#a77 that may be affected by the provisions of1 and amendments made by1 this section regarding such provisions and amendments4 7#b7 ,consultation ,in implementing the outreach plan developed under paragraph 7#a71 the ,secretary of ,health and ,human ,services shall consult with consumer advocates1 brokers1 insurers1 the ,national ,association of ,insurance ,commissioners1 and ,state ,health ,insurance ,assistance ,programs4 #c4 ,limitations on pricing discrimination 7a7 ,in general ,section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 is amended by adding at the end the following new subsection3 7aa7 ,development of new standards relating to pricing discrimination 7#a7 ,in general ,the ,secretary shall request the ,national ,association of ,insurance ,commissioners to review and revise the standards for all benefit packages under subsection 7p77#a71 including the core benefit package1 in order to provide coverage consistent with paragraph 7#b74 ,such revisions shall be made consistent with the rules applicable under subsection 7p77#a77;,e7 7with the reference to the #aiia ,,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 subsection74 7#b7 ,changes in cost-sharing described ,under the revised standards1 coverage shall not be available under a ,medicare supplemental insurance policy unless the issuer of the policy1 in addition to conforming to the other applicable requirements of this section-- 7,a7 does not discriminate in the pricing of the policy because of the age or health status of the individual to whom the policy is issued2 7,b7 does not1 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 7#b7 or 7#c7 of section #ahaa1 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 paragraph2 and 7,c7 does not establish premiums applicable under such policy on a basis that would apply to a portion of1 but not the entirety of1 a metropolitan statistical area4 7#c7 ,application date ,the revised standards shall apply to benefit packages sold1 issued1 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 #a1 #bjbc4 4 7b7 ,conforming amendment ,section #ahhb7o77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7o77#a77 is amended by striking 1 and 7y7 and inserting 7y71 and 7aa74 #d4 ,clarification regarding standardized ,medigap plans ,section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess71 as amended by section 7#c71 is amended by adding at the end the following new subsection3 7bb7 ,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 package4 ,an issuer of a ,medicare supplemental policy may offer such additional standardized benefits through a separate rider4 4 #e4 ,improving information available to ,medicare beneficiaries 7a7 ,clarifying beneficiary options on the ,medicare plan finder website ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended by adding at the end the following new subsections3 7e7 ,in the case that the ,secretary provides for a ,medicare plan finder ,internet website of the ,centers for ,medicare ,medicaid ,services 7or a successor website71 the ,secretary shall1 with respect to such website and in accordance with subsection 7f7-- 7#a7 consult with at least one independent entity that represents consumers in the development of such website2 7#b7 make available on such website-- 7,a7 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 ,b1 under part ,c1 and in ,medicare supplemental policies under section #ahhb2 7,b7 a review of out-of-pocket expenditures1 including deductibles1 copayments1 coinsurance1 monthly premiums1 and estimated annual out-of-pocket costs1 displayed overall and by components1 based on the best available information as determined by the ,secretary and based on the individual's specific health status2 7,c7 during the period prior to ,january #a1 #bjbc1 information regarding the rules that1 in each ,state1 pertain to guaranteed issue of ,medicare supplemental health insurance policies prior to implementation of the provisions of the ,medigap ,consumer ,protection ,act of #bjai and1 in the case that a ,state has no such rules pertaining to guaranteed issue of such policies1 clear language explaining the implications of such lack of rules for individuals with pre-existing conditions2 and 7,d7 clear information on local resources for individuals1 such as information on their ,state ,health ,insurance ,assistance ,program 7,,ship72 7#c7 not later than ,january #a1 #bjba1 and periodically thereafter1 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 title2 and 7#d7 not later than #ab months after the last day of each period for the request for information under subsection 7f71 update such website1 taking into consideration the information collected pursuant to such subsection1 to clarify the presentation of consumer options for ,medicare supplemental health insurance policy options1 including by presenting such information in a manner calculated to be understood by the average consumer and in a manner that-- 7,a7 improves consumer access to information regarding the applicable premiums under such policy options as of the date on which such website is so updated2 7,b7 facilitates consumers' ability to compare and sort policy options and premium information across plan offerings in a given location2 7,c7 clarifies and explains differences in policy value2 7,d7 rates and explains the financial stability of issuers of such policies2 7,e7 provides data on the inflation rate of different policies2 7,f7 provides information regarding the guaranteed issue requirements that apply to ,medicare supplemental health insurance policies under section #ahhb7s72 and 7,g7 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 ,d4 7f7 ,not later than #f months after the date of the enactment of this subsection and beginning on ,december #g of each year thereafter1 the ,secretary of ,health and ,human ,services shall provide an opportunity for public comment during which the ,secretary requests information1 including recommendations1 from stakeholders regarding potential improvements to the presentation of ,medicare supplemental health insurance policy options under section #ahhb on the ,medicare plan finder ,internet website of the ,centers for ,medicare ,medicaid ,services 7or a successor website74 7g7 ,with respect to any information that the ,secretary makes available on the ,medicare plan finder ,internet website of the ,centers for ,medicare ,medicaid ,services 7or a successor website7 pursuant to subsection 7e71 the ,secretary shall1 prior to making such information available-- 7#a7 provide1 in consultation with the ,national ,association of ,insurance ,commissioners1 an opportunity for consumer testing of such information2 7#b7 share the results of such consumer testing of such information with interested stakeholders2 and 7#c7 provide a #fj-;day public comment period with respect to such information4 4 7b7 ,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 of1 and amendments made by1 this ,act1 the ,secretary shall consult with at least one independent entity that represents consumers4 7c7 ,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-- 7#a7 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 program1 or vice versa2 and 7#b7 the volume of such information is equally weighted between such programs4 #f4 ,broker conflicts of interest ,section #aabh;,g of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7 is amended-- 7#a7 in subsection 7c77#a77;,a71 by striking #bjaa1 and inserting #bjaa 7or1 with respect to information required to be submitted under subsection 7f77#a71 not later than #f months after the date of the enactment of such subsection712 and 7#b7 by adding at the end the following new subsection3 7f7 ,application to ,medigap insurance brokers 7#a7 ,in general ,beginning not later than #ab months after the date of enactment of this subsection1 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 agents1 brokers1 and other third parties representing such policy4 ,each such report shall include the following information1 with respect to such a payment or other transfer of value3 7,a7 ,the name of the recipient of the payment or other transfer of value4 7,b7 ,the business address of the recipient4 7,c7 ,the amount of the payment or other transfer of value4 7,d7 ,the dates on which the payment or transfer of value was provided4 7,e7 ,a description of the form of the payment or transfer of value4 7,f7 ,any other categories of information the ,secretary determines appropriate4 7#b7 ,application of transparency system ,the provisions of subsections 7b7 through 7d7 shall apply to an issuer described in paragraph 7#a71 information required to be reported under such paragraph1 and agents1 brokers1 and other third parties described in such paragraph in the same manner and to the same extent as such provisions apply to an applicable manufacturer1 information required to be reported under subsection 7a71 and a covered recipient4 4 #g4 ,protecting against high out-of-pocket expenditures for ,medicare fee-for-service benefits ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,protection against high out-of-pocket expenditures 7a7 ,in general ,notwithstanding any other provision of this title1 in the case of an individual entitled to1 or enrolled for1 benefits under part ,a or enrolled in part ,b1 if the amount of the out-of-pocket cost-sharing of such individual for a year 7beginning with #bjbb7 equals or exceeds the annual out-of-pocket limit under subsection 7b7 for that year-- 7#a7 the amount otherwise payable under part ,a and the total amount of expenses incurred by the individual which would 7except for this section7 constitute incurred expenses for which benefits are payable under part ,b1 shall be #ajj percent of such amount for the remainder of that year2 and 7#b7 the individual shall not be responsible for out-of-pocket cost-sharing incurred during the remainder of that year4 7b7 ,annual out-of-,pocket limit 7#a7 ,in general ,the amount of the annual out-of-pocket limit under this subsection shall be-- 7,a7 for #bjbb1 #e1ejj2 or 7,b7 for a subsequent year1 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 #ab-month period ending with ,june of such preceding year4 7#b7 ,rounding ,if any amount determined under paragraph 7#a77;,b7 is not a multiple of #e1 such amount shall be rounded to the nearest multiple of #e4 7c7 ,out-of-,pocket cost-,sharing defined 7#a7 ,in general ,subject to paragraphs 7#b7 and 7#c71 in this section1 the term out-of-pocket cost-sharing means1 with respect to an individual1 the amount of the expenses incurred by the individual that are attributable to-- 7,a7 deductibles1 coinsurance and copayments applicable under part ,a or ,b2 or 7,b7 for items and services that would have otherwise been covered under part ,a or ,b but for the exhaustion of those benefits4 7#b7 ,certain costs not included 7,a7 ,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 7#a74 7,b7 ,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 basis1 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 7#a74 7#c7 ,source of payment ,for purposes of paragraph 7#a71 the ,secretary shall consider expenses to be incurred by the individual without regard to whether the individual or another person1 including a ,state program1 an employer1 a ,medicare supplemental policy1 or other third-party coverage1 has paid for such expenses4 7d7 ,announcement of the annual out-of-,pocket limit ,the ,secretary shall 7beginning in #bjba7 announce 7in a manner intended to provide notice to all interested parties7 the annual out-of-pocket limit under this section that will be applicable for the succeeding year4 4 #h4 ,study and report on variations among ,medigap plans 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the variations among ,medicare supplemental policies under section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess74 ,such study shall include an analysis of the following3 7#a7 ,how the variations among such policies impacts ,medicare beneficiaries' choices4 7#b7 ,ways to improve standardization and tools to help ,medicare beneficiaries make informed choices with respect to such policies4 7#c7 ,other items determined appropriate by the ,comptroller ,general4 7b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4