H.R.610 - Close the Medigap Act of 2025 (119th Congress)
Summary
H.R.610, the "Close the Medigap Act of 2025," aims to reform Medicare supplemental health insurance policies. Key provisions include guaranteed issue of Medigap policies, adjustments to the medical loss ratio, and limitations on pricing discrimination based on age or eligibility for certain Medicare programs. The bill also seeks to improve transparency and access to information for beneficiaries through the Medicare Plan Finder website and requires brokers to report payments received from Medigap insurers.
Expected Effects
The bill intends to expand access to Medigap policies, reduce discriminatory pricing practices, and enhance consumer information. This could lead to increased enrollment in Medigap plans and potentially higher premiums for some beneficiaries. The changes aim to provide more comprehensive coverage and greater financial protection for Medicare recipients.
Potential Benefits
- Ensures guaranteed issue of Medigap policies, preventing denial of coverage based on health status or pre-existing conditions.
- Limits pricing discrimination based on age or eligibility for specific Medicare programs, promoting fairer access.
- Enhances transparency through broker reporting requirements, potentially reducing conflicts of interest.
- Improves the Medicare Plan Finder website with better information on plan options and costs.
- Restores access to first-dollar Medigap coverage, eliminating cost-sharing for some beneficiaries.
Most Benefited Areas:
Potential Disadvantages
- Increased premiums for some beneficiaries due to guaranteed issue and limitations on pricing discrimination.
- Potential administrative burden for insurers and brokers due to new reporting requirements.
- The phase-in period could create confusion and uncertainty for beneficiaries.
- The reliance on the National Association of Insurance Commissioners (NAIC) for setting medical loss ratio standards may not always align with consumer interests.
- The bill's complexity could make it difficult for some beneficiaries to understand their options and make informed choices.
Constitutional Alignment
The bill's provisions related to healthcare access and consumer protection align with the general welfare clause of the Constitution (Preamble). Congress has the power to legislate on matters related to Social Security and Medicare under the Necessary and Proper Clause (Article I, Section 8). The bill does not appear to infringe upon any specific individual rights or liberties protected by the Bill of Rights.
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).