Medicare Enrollment Protection Act of 2025

Bill Number

H.R. 2744

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-04-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2026-03-25T08:05:31Z

AI-Generated Summary

Purpose of the Legislation

The Medicare Enrollment Protection Act of 2025 aims to facilitate a smoother transition for individuals eligible for Medicare who are currently using COBRA continuation coverage—a temporary extension of employer-sponsored health insurance after events like job loss. It creates special rules to allow these individuals to enroll in Medicare Part B (which covers doctor visits and outpatient care) without facing late enrollment penalties or coverage gaps.

Key Provisions

• Special Enrollment Period: Individuals who become eligible for Medicare while enrolled in COBRA (or who enroll in COBRA right after becoming eligible) can sign up for Medicare Part B during their entire time on COBRA, plus an additional 3 months after COBRA ends. This applies only once per person's lifetime and starts for COBRA coverage on or after January 1, 2026.
• Coverage Start Date: For those enrolling under this special period, Medicare Part B coverage begins on the first day of the month following enrollment.
• No Premium Penalty: People transitioning from COBRA to Medicare won't face higher premiums (late enrollment fees) for any months they can prove they were covered by COBRA.
• Coordination of Benefits:
• COBRA plans (governed by federal laws like ERISA, the Public Health Service Act, or the Internal Revenue Code) cannot reduce or end benefits just because the person is eligible for Medicare Part B but hasn't enrolled yet. Benefits must continue as if the person weren't eligible for Medicare.
• However, once the person enrolls in Medicare Part B, the COBRA plan can end or adjust benefits accordingly.
• Updated Notifications: By January 1, 2026, the Department of Labor (in consultation with Health and Human Services) must update COBRA notices to explain Medicare's "secondary payer" rules—meaning Medicare pays second to primary coverage like COBRA—and how they interact.

COBRA here includes federal employee plans and similar state laws providing comparable group health coverage extensions.

Significant Changes to Existing Law

• Adds a new subsection to the Social Security Act (Section 1837(i)) for the special enrollment period, expanding beyond current exceptions like employer group plans.
• Modifies Medicare premium rules (Section 1839(b)) to waive penalties specifically for COBRA months, unlike standard rules that penalize delays.
• Amends coverage effective dates (Section 1838(e)) to align with the new enrollment window.
• Introduces coordination rules in ERISA (Section 607), the Public Health Service Act (Section 2208), and the Internal Revenue Code (Section 4980B), preventing COBRA plans from penalizing Medicare eligibility—a shift from prior rules that might have allowed such adjustments.
• Requires explicit updates to COBRA notices, which previously did not detail Medicare interactions.

These changes apply only to COBRA starting in 2026, leaving pre-2026 coverage unchanged.

Potential Impacts

• On Citizens: Reduces financial and coverage risks for Medicare-eligible adults (typically age 65+) who lose job-based insurance, allowing them to maintain health benefits during transitions without penalties that could add 10% per year delayed to lifetime premiums.
• On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) may see increased enrollments and administrative workload for verifying COBRA proof. Departments of Labor and Health and Human Services must implement notice updates and coordination guidance.
• On Employers and Health Plans: COBRA administrators (employers or insurers) face new requirements to maintain full benefits during Medicare eligibility periods and update notices, potentially increasing short-term costs but preventing disputes.
• No Notable International Relations Impact: The bill is domestic, focused on U.S. health insurance systems.

Main Stakeholders Affected

• Individuals: Primarily working-age adults nearing or at Medicare eligibility (65+) who experience qualifying events for COBRA, such as layoffs or reduced hours.
• Employers and Insurers: Those offering group health plans under COBRA, including private companies, federal agencies (for employee plans), and state programs.
• Government Entities: CMS (for Medicare administration), Department of Labor (for ERISA notices), and Health and Human Services (for coordination and guidance).
• Health Care Providers: Indirectly, through smoother patient coverage transitions reducing unpaid care.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens coordination between private (COBRA) and public (Medicare) insurance under federal law, clarifying "secondary payer" rules to avoid conflicts. It doesn't alter core Medicare eligibility but expands access, potentially reducing litigation over denied claims or penalties.
• Constitutional: No direct challenges; aligns with Congress's authority over interstate commerce and social welfare programs like Social Security.
• Political: Bipartisan sponsorship (introduced by Rep. Smucker with cosponsors from both parties) suggests broad support for protecting older workers' health access amid job market instability. Could influence future health policy by modeling seamless insurance handoffs, though implementation costs may spark budget debates in committees like Energy and Commerce.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Smucker, Lloyd [R-PA-11]

Cosponsors (7)

Rep. Bilirakis, Gus M. [R-FL-12], Rep. Houchin, Erin [R-IN-9], Rep. Thompson, Mike [D-CA-4], Rep. Craig, Angie [D-MN-2], Rep. Norcross, Donald [D-NJ-1], Rep. Shreve, Jefferson [R-IN-6], Rep. Davids, Sharice [D-KS-3]

Recent Actions

• 2025-04-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-04-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-04-08: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-04-08: Introduced in House
• 2025-04-08: Introduced in House

Bill Versions

• Medicare Enrollment Protection Act of 2025 — issued 2025-04-08 — PDF (8 pages)