Bill · H.R. 3467· House(119-HR-3467)
To amend title XVIII to reform the Medicare Advantage program.
- Introduced
- 5/15/2025
- Last activity
- 6/3/2025 — Sponsor introductory remarks on measure. (CR H2408-2410)
- Sponsored by
- David Schweikert
- Cosponsors
- None
- Introduced
What this bill would do
This bill proposes several reforms to the Medicare Advantage program starting in 2028. It requires most Medicare Advantage plans to pay for benefits on a capitated basis, with specific exceptions for certain existing plans and special needs plans. The legislation modifies payment benchmarks, risk adjustment requirements, and eliminates certain quality benchmark increases. It also introduces a system for stop-loss payments to the Secretary for plans with high expenditures. Additionally, the bill implements automatic enrollment into low-premium plans and establishes a mandatory continuous enrollment period for those who join.
Yes
Does this lower what people pay for private health insurance?+4
The automatic enrollment into the lowest-premium plans is intended to reduce costs for individuals.
Would households on low incomes be better off under this?+3
Automatic enrollment in lowest-premium plans may help low-income seniors manage healthcare costs.
The opposite· 3 of 5
Does this put more money into Medicare, the health coverage for people over 65?-3
The bill reduces the blended benchmark and eliminates quality benchmark increases for Medicare Advantage plans.
Would people over 65 be better off under this?-2
The bill imposes enrollment restrictions and changes to risk adjustment that could negatively affect seniors on Medicare Advantage.
Would retired people be better off under this?-2
The bill introduces a three-year mandatory continuous enrollment period which limits plan switching flexibility for retirees.
Who it would affect, and how
Potential Positive Impacts for People
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Lower Premium Options: The bill mandates the automatic enrollment of individuals into the Medicare Advantage plan with the lowest available premium, which may benefit those looking for the least expensive option (Section 1859A(a)(1)).
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Protection Against High Expenditures: The Secretary may establish stop-loss payments for Medicare Advantage plans that experience significantly higher expenditures compared to expected amounts (Section 1853(p)(1)).
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Hardship Exceptions: Individuals who are subject to mandatory continuous enrollment can avoid those restrictions if they experience a hardship event, such as a serious illness (Section 1859A(b)(2)).
Potential Negative Impacts for People
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Enrollment Restrictions: Once an individual enrolls in a Medicare Advantage plan, they may be prohibited from joining another plan or switching back to traditional fee-for-service Medicare for a three-year period (Section 1859A(b)(1)).
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Limited Plan Choice for Certain Groups: For certain plans, new individuals might be barred from enrolling if the plan was already made available in the preceding year, as those plans may only allow enrollment for people who were already in them (Section 1852(o)(2)(A)).
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Changes to Risk Adjustment: The rules for determining risk adjustment based on health status will be restricted to diagnoses from face-to-face or telehealth visits, excluding diagnoses from chart reviews or stand-alone health risk assessments (Section 1853(a)(3)(E)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Low Income Households+3Good For Retirees-2Good For Seniors-2Good For People With Disabilities-1
- Healthcare
- Reduces Private Insurance Premiums+4Increases Medicare Funding-3Improves Healthcare Access-2
- 6/3/2025
- Sponsor introductory remarks on measure. (CR H2408-2410)
- 5/15/2025
- 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.
- Introduced in House