H.R. 9532: No Medicare Clawbacks Act of 2026

This bill would change Medicare-related rules for certain people who also have employer group health coverage.

Under current law, if Medicare Part A coverage is later applied retroactively to someone, an employer group health plan may have a basis to say Medicare should have been primary and may try to recoup money it already paid for the person’s medical care. A “recoupment” or “clawback” means the plan tries to get money back after paying a claim.

The bill would bar that kind of clawback in a specific situation:

• The person is entitled to Medicare benefits under Part A.
• The person is also enrolled in a group health plan.
• The item or service was provided during a period when Medicare Part A coverage applies retroactively.
• The group health plan originally paid the claim without considering the person’s Medicare entitlement.
• The person was not behind on any required employee contributions for that health plan at the time.

If those conditions are met, the plan would not be allowed to later take back all or part of its payment just because the person was retroactively covered by Medicare.

The bill also updates the penalty/enforcement language in the Social Security Act so that plans that recoup payments in violation of this new rule can be treated as violating the statute.

In plain terms, the bill is meant to prevent someone from being caught in the middle after an employer health plan pays a medical bill and then later tries to reverse that payment because Medicare coverage is found to have applied earlier than expected.

Relevant Companies

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