Close the Medigap Act of 2025
Summary
What This Bill Does
The Close the Medigap Act of 2025 substantially changes Medicare supplemental insurance rules. It requires Medigap issuers to offer guaranteed issue without denying or conditioning coverage, charging more based on health status, imposing preexisting-condition exclusions, or limiting enrollment windows, with implementation beginning January 1, 2026 and full implementation by January 1, 2031. It requests NAIC model changes and requires Medigap pricing rules that prevent discrimination by age, disability, end-stage renal disease eligibility, or partial-county premium areas for newly entitled or enrolled beneficiaries after January 1, 2026. It directs CMS to improve Medicare Plan Finder information on provider network access, out-of-pocket costs, premiums, State guaranteed issue protections, financial stability, and plan value. It also requires Medigap issuers to report annual payments or transfers of value to agents, brokers, and third parties within 12 months, creating Open Payments-style transparency for Medigap sales incentives.
Who Benefits and How
Medicare beneficiaries seeking Medigap coverage benefit from guaranteed issue protections and limits on health-status discrimination. Beneficiaries under age 65 with disability or end-stage renal disease benefit from pricing rules intended to prevent access from being jeopardized. Beneficiaries comparing Medicare options benefit from improved Medicare Plan Finder data on costs, networks, premiums, State rules, and plan value. Consumer advocates and State Health Insurance Assistance Programs benefit from clearer federal outreach and comparison information. Medigap policyholders benefit from public reporting of broker and agent compensation that may influence sales recommendations.
Who Bears the Burden and How
Medigap issuers must accept more applicants, remove preexisting-condition exclusions, adjust pricing rules, and report compensation transfers. Agents, brokers, and third-party marketers face public reporting of payments and other transfers of value from Medigap issuers. CMS Plan Finder staff must update comparison tools, review information, and request or display more plan data. HHS and NAIC standard-setting staff must coordinate outreach, model standards, implementation timelines, and periodic reviews. State insurance regulators may need to align Medigap oversight with federal guaranteed issue and pricing rules.
Key Provisions
- Requires Medigap guaranteed issue without health-status discrimination or preexisting-condition exclusions.
- Requires implementation beginning January 1, 2026, with full implementation by January 1, 2031.
- Restricts Medigap pricing discrimination based on age, disability, end-stage renal disease status, or partial-county areas.
- Requires Medicare Plan Finder improvements for provider networks, out-of-pocket costs, premiums, State protections, and plan value.
- Requires annual public reporting of Medigap issuer payments to agents, brokers, and third parties.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Requires guaranteed issue and nondiscriminatory pricing for Medigap policies, improves Medicare Plan Finder comparison information, and requires annual public reporting of Medigap issuer payments to agents, brokers, and other third parties.
Key Policy Areas
Medicare, Medigap, Health Insurance, Broker Transparency
Primary Purpose
Requires guaranteed issue and nondiscriminatory pricing for Medigap policies, improves Medicare Plan Finder comparison information, and requires annual public reporting of Medigap issuer payments to agents, brokers, and other third parties.
Policy Domains
Substantive provisions
Identified Gains
- Medicare beneficiaries seeking Medigap coverage
- Beneficiaries under age 65 with disability
- Beneficiaries with end-stage renal disease
- Medicare Plan Finder users
- Consumer advocates
- State Health Insurance Assistance Programs
- Medigap policyholders
Identified Costs
- Medigap issuers
- Agents and brokers selling Medigap policies
- Third-party Medigap marketers
- CMS Plan Finder staff
- HHS Medigap policy staff
- State insurance regulators
Sponsors
Legislative Progress
In CommitteeMr. Doggett (for himself, Mr. Bishop, Mr. Carson, Mr. Casar, …
Referred to the Committee on Ways and Means, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Beneficiaries under age 65 with disability, Beneficiaries with end-stage renal disease, Medicare Plan Finder users
Medicare Advantage and prescription drug plans, Medigap issuers, Medigap issuers providing comparison data
CMS Plan Finder staff, HHS Medigap outreach staff, HHS Open Payments-style reporting staff
State Health Insurance Assistance Programs, State insurance regulators
Positive-direction: State Health Insurance Assistance Programs
Negative-direction: State insurance regulators
Consumer advocates monitoring Medigap sales
Agents and brokers selling Medigap policies
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology