To amend title XVIII of the Social Security Act to impose limitations on contracts with Medicare Advantage organizations offering multiple Medicare Advantage plans under the Medicare program.
- Bill Number
- H.R. 6113
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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
- 2025-12-02T09:05:23Z
AI-Generated Summary
Purpose
This bill aims to restrict the number of Medicare Advantage (MA) plans that private organizations can offer under contracts with the federal government, promoting simplicity and differentiation in plan offerings to improve oversight and beneficiary choice in the Medicare program.
Key Provisions
- Limit on Total Plans: Starting one year after enactment, the Secretary of Health and Human Services (HHS) cannot enter into or renew contracts with a Medicare Advantage organization for more than 3 MA plans offered in a single plan year.
- Requirement for Differentiation: The Secretary cannot approve contracts for more than 1 MA plan unless each additional plan is significantly different in terms of premiums (monthly costs), benefits (covered services), or cost-sharing structure (out-of-pocket expenses like deductibles or copays), as determined by the Secretary.
Significant Changes to Existing Law
- Adds a new subsection (j) to Section 1857 of the Social Security Act (which governs MA contracts).
- Introduces explicit numerical and qualitative limits on MA plans per organization, which do not currently exist; previously, organizations could offer an unlimited number of plans without mandatory differentiation requirements.
Potential Impacts
- On Government Agencies: HHS may face reduced administrative burden from fewer plans to review and monitor, potentially streamlining contract approvals and regulatory oversight.
- On Citizens (Medicare Beneficiaries): Could limit the variety of MA plan options available, possibly simplifying choices but reducing access to tailored plans; might encourage more distinct plans to meet the differentiation rule.
- On International Relations: No direct impact, as this is a domestic health policy measure.
Main Stakeholders Affected
- Medicare Advantage Organizations: Private insurers offering MA plans; they may need to consolidate or redesign offerings to comply, potentially affecting profitability and market strategies.
- Medicare Beneficiaries: Seniors and people with disabilities enrolled in Medicare; changes could influence plan availability and costs in their areas.
- Federal Government (HHS and CMS): The Centers for Medicare & Medicaid Services (CMS), under HHS, will enforce the limits, requiring new evaluation processes for plan differences.
Notable Legal, Constitutional, or Political Implications
- Legal: Establishes enforceable criteria for contract approvals, giving the Secretary broad discretion to define "significant differences," which could lead to future litigation over interpretations or denials.
- Constitutional: No apparent challenges, as it regulates federal spending and contracts under Congress's spending power.
- Political: Sponsored by progressive Democrats, it may signal efforts to curb private insurer expansion in Medicare (a public program), potentially sparking debates on privatization versus government control of healthcare options.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (15)
Rep. Carson, André [D-IN-7], Rep. Cohen, Steve [D-TN-9], Rep. DeLauro, Rosa L. [D-CT-3], Rep. Doggett, Lloyd [D-TX-37], Rep. Jayapal, Pramila [D-WA-7], Rep. Khanna, Ro [D-CA-17], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Ocasio-Cortez, Alexandria [D-NY-14], Rep. Schakowsky, Janice D. [D-IL-9], Rep. Takano, Mark [D-CA-39], Rep. Thanedar, Shri [D-MI-13], Rep. Tlaib, Rashida [D-MI-12], Rep. Omar, Ilhan [D-MN-5], Rep. Dingell, Debbie [D-MI-6], Rep. Casar, Greg [D-TX-35]
Recent Actions
- 2025-11-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2025-11-18: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2025-11-18: Introduced in House
- 2025-11-18: Introduced in House
Bill Versions
- To amend title XVIII of the Social Security Act to impose limitations on contracts with Medicare Advantage organizations offering multiple Medicare Advantage plans under the Medicare program. — issued 2025-11-18 — PDF (2 pages)