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.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
Bars enrollment and reenrollment in a Medicare Advantage plan if the plan's average monthly payment exceeds the average cost of traditional Medicare, with an exception for certain special-needs plans.
Who Benefits and How
Federal payers could benefit from pressure to curb higher-cost Medicare Advantage plans relative to traditional Medicare.
Who Bears the Burden and How
Medicare Advantage plans with higher average monthly costs could lose the ability to enroll or reenroll members for the next plan year.
Key Provisions
- Requires HHS to block enrollment and reenrollment in a Medicare Advantage plan if its average monthly payment exceeds traditional Medicare's average cost.
- Exempts specialized MA plans for special needs individuals from the rule.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Bars enrollment and reenrollment in a Medicare Advantage plan if the plan's average monthly payment exceeds the average cost of traditional Medicare, with an exception for certain special-needs plans.
Key Policy Areas
Healthcare, Government Operations, Finance
Primary Purpose
Bars enrollment and reenrollment in a Medicare Advantage plan if the plan's average monthly payment exceeds the average cost of traditional Medicare, with an exception for certain special-needs plans.
Policy Domains
Main Provisions
Identified Gains
Contextual inference, no direct clause citation- Federal Medicare payers seeking lower-cost plan options
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Higher-cost Medicare Advantage plans facing enrollment restrictions
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMr. Pocan (for himself, Mr. Carson, Mr. Cohen, Ms. DeLauro, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Federal Medicare payers seeking lower-cost plan options
Higher-cost Medicare Advantage plans facing enrollment restrictions
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