H.R. 6112: 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.

This bill proposes an amendment to the Social Security Act that would impose specific requirements on Medicare Advantage plans regarding their average monthly costs for enrollees. Below is a summary of its main provisions:

Requirements for Medicare Advantage Plans

The bill introduces a requirement for Medicare Advantage plans, which are private insurance options offered to Medicare beneficiaries, related to their average monthly costs. Specifically, it states that:

• Starting one year after the bill is enacted, if the average monthly payment made to a Medicare Advantage plan exceeds the average monthly cost of coverage under the original Medicare fee-for-service program (Parts A and B), the Secretary of Health and Human Services will not allow any new enrollments or reenrollments in that Medicare Advantage plan for the following year.
• This restriction is designed to ensure that Medicare Advantage plans do not have significantly higher costs compared to traditional Medicare coverage, thereby protecting enrollees from potentially higher expenditures.
• There is an exception to this rule for specialized Medicare Advantage plans that cater to individuals with special needs, which will not be subject to the enrollment restrictions based on average costs.

Implementation Timeline

The amendment would take effect for plan years beginning one year after its enactment. This provides time for the necessary adjustments to be made both by the Medicare Advantage plans and the regulatory bodies overseeing these programs.

Impact on Enrollees

The primary goal of this bill is to protect Medicare beneficiaries by limiting their options for enrollment in Medicare Advantage plans when those plans are deemed to be more expensive than traditional Medicare. This could create a more competitive environment among Medicare Advantage plans, potentially leading to lower costs for enrollees.

Relevant Companies

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