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Limiting High-Cost Medicare Advantage Plans: New Enrollment Rules.

This bill establishes new cost requirements for private Medicare Advantage (MA) plans. If the average monthly payment the government makes to an MA plan exceeds the cost of providing coverage under Original Medicare, that specific MA plan will be closed to new and existing enrollment the following year. This aims to control government spending on MA plans that are significantly more expensive than the standard program, potentially affecting plan availability for beneficiaries.
Key points
Medicare Advantage plans deemed too costly compared to Original Medicare will face mandatory enrollment bans.
Citizens will be prevented from enrolling or re-enrolling in MA plans that exceed the established cost threshold.
Specialized MA plans designed for individuals with special health needs are exempt from this new cost requirement.
article Official text account_balance Process page
Introduced
Citizen Poll
No votes cast
Additional Information
Print number: 119_HR_6112
Sponsor: Rep. Pocan, Mark [D-WI-2]
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Summarized by: gemini-2.5-flash-preview-09-2025
Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

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.

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 119_HR_6112.

Which chamber initiated this legislation?

This legislation was initiated in the House of Representatives.

What are the main provisions?

Key points include:

  • Medicare Advantage plans deemed too costly compared to Original Medicare will face mandatory enrollment bans.
  • Citizens will be prevented from enrolling or re-enrolling in MA plans that exceed the established cost threshold.
  • Specialized MA plans designed for individuals with special health needs are exempt from this new cost requirement.
What is the specific legal status?

The current status is Introduced.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Rep. Pocan, Mark [D-WI-2].

What is the latest detailed status?

The latest detailed status is: Introduced in House

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-23.

CATEGORIES

Health Benefits