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.
Sponsored By: Representative Pocan
Introduced
Summary
Would add a cost-based enrollment gate that stops people from joining Medicare Advantage plans when a plan’s per-person payments exceed the comparable fee-for-service cost. It ties an MA plan’s eligibility to a year-to-year comparison of the plan’s average monthly payment and the Parts A and B fee-for-service monthly cost and would bar enrollment in the subsequent plan year if the plan is higher cost.
Show full summary
- Medicare beneficiaries: Would be unable to enroll or reenroll in an MA plan for the plan year after the Secretary determines that the plan’s average monthly payment exceeds the fee-for-service monthly cost. This affects new and returning enrollees for that specific plan year.
- Medicare Advantage plans and issuers: Plans with per-enrollee payments above the original Medicare Parts A and B cost would be barred from taking new or returning enrollees for the next plan year. Specialized Medicare Advantage plans for special needs individuals are explicitly exempt.
- Medicare program oversight and costs: Creates a cost-parity rule linking enrollment access to per-member cost comparisons and would start with plan years beginning one year after enactment. This is a targeted enrollment control based on payment-to-cost comparisons.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 1 costs, 0 mixed.
Freeze enrollments in costly Medicare Advantage plans
If enacted, HHS would compare each Medicare Advantage plan’s average monthly payment to the average monthly cost of original Medicare (Parts A and B). If a plan costs more, the Secretary would stop all new enrollments and reenrollments in that plan for the next plan year. This would start for plan years that begin at least one year after enactment. Specialized Medicare Advantage plans for special needs individuals would be exempt.
Sponsors & CoSponsors
Sponsor
Pocan
WI • D
Cosponsors
Carson
IN • D
Sponsored 11/18/2025
Cohen
TN • D
Sponsored 11/18/2025
DeLauro
CT • D
Sponsored 11/18/2025
Doggett
TX • D
Sponsored 11/18/2025
Jayapal
WA • D
Sponsored 11/18/2025
Khanna
CA • D
Sponsored 11/18/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 11/18/2025
Ocasio-Cortez
NY • D
Sponsored 11/18/2025
Schakowsky
IL • D
Sponsored 11/18/2025
Takano
CA • D
Sponsored 11/18/2025
Thanedar
MI • D
Sponsored 11/18/2025
Tlaib
MI • D
Sponsored 11/18/2025
Omar
MN • D
Sponsored 11/18/2025
Dingell
MI • D
Sponsored 11/20/2025
Casar
TX • D
Sponsored 12/1/2025
Roll Call Votes
No roll call votes available for this bill.
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