H.R. 610 — Close the Medigap Act of 2025

This section revises guaranteed issue requirements in Section 1882(s) of the Social Security Act for Medicare supplemental policies (i.e., Medigap policies that cover Medicare cost-sharing such as deductibles and coinsurance). Specifically, it prohibits issuers from (1) denying or conditioning issuance or effectiveness of such a policy, or discriminating in pricing, based on an individual's health status, claims experience, receipt of health care, medical condition, or genetic information; (2) excluding benefits or imposing waiting, elimination, or probationary periods based on preexisting conditions; (3) denying or conditioning issuance of a policy offered and available to new enrollees; or (4) limiting enrollment periods (except for individuals entitled to Medicare Part A solely by reason of section 226A). It preserves issuers' authority, as otherwise permitted, to deny or condition policies or adjust premiums for employers or individuals based on manifested diseases or disorders (without using one individual's manifestation as genetic information for others). This section further directs the Secretary of Health and Human Services to develop an outreach plan notifying Medicare beneficiaries of these changes, in consultation with consumer advocates, brokers, insurers, the National Association of Insurance Commissioners, and State Health Insurance Assistance Programs. The amendments apply to Medicare supplemental policies effective on or after January 1, 2026, with Secretary phase-in authority through full implementation by January 1, 2031. (Thus, guaranteed issue protections become available to all individuals entitled to Medicare Part A and enrolled in Part B, subject to the exception.)

This section revises medical loss ratio (MLR) requirements for Medicare supplemental policies by (1) requiring the relevant standards, as developed by the National Association of Insurance Commissioners, to be periodically reviewed; and (2) maintaining the current minimum MLR of at least 75% of premiums collected for group policies and 65% for individual policies through periods ending before January 1, 2026, and requiring for periods beginning on or after such date an MLR equal to or greater than both those percentages and any percentage recommended by the National Association of Insurance Commissioners to the Secretary. (Thus, the minimum MLR on or after January 1, 2026, equals the higher of the current percentages or the recommended percentages.)

This section directs the Secretary of Health and Human Services to request the National Association of Insurance Commissioners (NAIC) to revise standards for Medicare supplemental insurance policies (Medigap)—which supplement Original Medicare coverage of deductibles, coinsurance, and copayments—to prohibit issuers from (1) discriminating in pricing based on the policyholder's age, (2) discriminating in pricing, to the extent it jeopardizes access for individuals newly eligible for Medicare hospital insurance due to age (65 or older) or disability, and (3) setting premiums based on only a portion of a county or equivalent area. The revised standards apply to Medigap policies sold, issued, or renewed for individuals who first become entitled to Medicare Part A or enroll in Part B on or after January 1, 2026.

This section requires the Secretary of Health and Human Services (HHS) to enhance the Medicare plan finder website (or successor) by (1) providing access to provider network information, out-of-pocket cost reviews (including deductibles, copayments, coinsurance, premiums, and annual estimates), and—prior to January 1, 2026—state-specific details on guaranteed issue rules for Medicare supplemental (Medigap) policies or implications for individuals with pre-existing conditions if no such rules exist; (2) conducting an initial review of the website by January 1, 2026, and periodic reviews thereafter to ensure it supplies information necessary for Medicare beneficiaries to make informed enrollment choices across Parts A, B, C (Medicare Advantage), and Medigap policies; and (3) updating the website within 12 months after each annual public comment period to improve presentation of Medigap options, including premium comparisons, policy value differences, issuer financial stability ratings, policy inflation data, guaranteed issue requirements under SSA section 1882(s)(3), and costs under Medicare Advantage and Part D plans. It further directs HHS to solicit stakeholder recommendations on Medigap information presentation via public comment opportunities beginning 6 months after enactment and annually starting December 7. Prior to implementing these website changes, HHS must conduct consumer testing (in consultation with the National Association of Insurance Commissioners), share results with stakeholders, and allow a 60-day public comment period. (The Medicare plan finder assists beneficiaries in comparing and selecting among Original Medicare, Medicare Advantage plans, prescription drug plans, and Medigap policies, which help cover gaps in Original Medicare.)

This section expands the Open Payments transparency reporting requirements under Section 1124G of the Social Security Act to Medicare supplemental health insurance (Medigap) policy issuers by (1) modifying the initial reporting deadline in subsection (c)(1)(A) to six months after enactment for information under new subsection (f)(1); and (2) requiring, beginning not later than 12 months after enactment, each such issuer to annually report to the Secretary payments or other transfers of value made in the prior year to agents, brokers, and other third parties, including the recipient's name and business address, amount, dates, form, and other categories determined appropriate by the Secretary. The existing public disclosure, accuracy, and other provisions of subsections (b) through (d) apply to these reports in the same manner as to applicable manufacturers' reports on payments to covered recipients (i.e., physicians and teaching hospitals).