To amend title XVIII of the Social Security Act to establish certain requirements with respect to the average monthly cost to provide coverage to an enrollee under Medicare Advantage plans.
Summary
H.R. 6112 aims to amend Title XVIII of the Social Security Act, focusing on Medicare Advantage plans. The bill seeks to establish requirements related to the average monthly cost of providing coverage to enrollees in these plans. Specifically, it addresses situations where the average monthly payment for a Medicare Advantage plan exceeds the average monthly cost for the original Medicare fee-for-service program.
Expected Effects
If enacted, H.R. 6112 could prevent individuals from enrolling or re-enrolling in Medicare Advantage plans that are deemed more expensive than the original Medicare program. This restriction would apply to plan years beginning one year after the bill's enactment. However, an exception is provided for specialized MA plans catering to special needs individuals.
Potential Benefits
- Potentially lowers costs for Medicare enrollees by limiting enrollment in more expensive plans.
- Could incentivize Medicare Advantage plans to become more cost-efficient.
- May ensure better value for taxpayer dollars by promoting cost-effectiveness in Medicare spending.
- Could lead to greater transparency in the cost structures of Medicare Advantage plans.
- May encourage enrollment in the original Medicare fee-for-service program.
Most Benefited Areas:
Potential Disadvantages
- May limit choices for individuals who prefer Medicare Advantage plans, even if they are more expensive.
- Could disrupt the Medicare Advantage market, potentially leading to fewer plan options.
- May not address the underlying reasons for cost differences between Medicare Advantage and original Medicare.
- Could disproportionately affect individuals in certain geographic areas where Medicare Advantage plans are prevalent.
- The definition of 'average monthly cost' may be subject to interpretation and manipulation.
Most Disadvantaged Areas:
Constitutional Alignment
The bill falls under the purview of Congress's power to legislate on matters related to healthcare and social welfare, as outlined in Article I, Section 8 of the Constitution, which grants Congress the power to provide for the general welfare of the United States. The bill does not appear to infringe upon any specific constitutional rights or freedoms. However, the implementation of the bill must ensure due process and equal protection under the law, as guaranteed by the Fifth and Fourteenth Amendments.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).