HR6112-119

1. Establishing requirements with respect to average monthly cost to provide coverage under Medicare Advantage plans Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph: Beginning with plan years beginning on or after the date that is 1 year after the date of the enactment of this paragraph, if the Secretary determines that, with respect to a plan year and a Medicare advantage plan, the average monthly payment amount under section 1853 with respect to coverage of individuals enrolled in such Medicare Advantage plan for such plan year exceeds the average monthly cost to provide coverage for individuals enrolled in the original Medicare fee-for-service program under parts A and B for such plan year, the Secretary shall not permit any individual to enroll or reenroll in such plan for the plan year immediately following such plan year. Subparagraph (A) shall not apply with respect to a specialized MA plan for special needs individuals. (6)Requirement on average monthly cost to provide coverage (A)In generalBeginning with plan years beginning on or after the date that is 1 year after the date of the enactment of this paragraph, if the Secretary determines that, with respect to a plan year and a Medicare advantage plan, the average monthly payment amount under section 1853 with respect to coverage of individuals enrolled in such Medicare Advantage plan for such plan year exceeds the average monthly cost to provide coverage for individuals enrolled in the original Medicare fee-for-service program under parts A and B for such plan year, the Secretary shall not permit any individual to enroll or reenroll in such plan for the plan year immediately following such plan year. (B)ExceptionSubparagraph (A) shall not apply with respect to a specialized MA plan for special needs individuals. .