Bill

Bill > HR6112


US HR6112

US HR6112
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

Introduced
11/18/2025
In Committee
11/18/2025
Crossed Over
Passed
Dead

Introduced Session

119th Congress

Bill Summary

A BILL 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.

AI Summary

This bill amends the Social Security Act to establish new requirements for Medicare Advantage (MA) plans regarding their average monthly costs. Specifically, the bill directs the Secretary of Health and Human Services to prevent new enrollments or reenrollments in an MA plan for the following year if the plan's average monthly payment amount exceeds the average monthly cost of the original Medicare fee-for-service program. This means that if an MA plan is found to be significantly more expensive than traditional Medicare, it would be barred from accepting new or returning patients in the subsequent plan year. The bill provides an exception for specialized MA plans that serve individuals with special needs, allowing those plans to continue enrolling patients regardless of their cost structure. The provision would take effect for plan years beginning one year after the bill's enactment, giving MA plans time to adjust their cost structures to comply with the new requirements.

Committee Categories

Budget and Finance

Sponsors (16)

Last Action

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. (on 11/18/2025)

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