November 18, 2025
Mr. Pocan (for himself, Mr. Carson, Mr. Cohen, Ms. DeLauro, Mr. Doggett, Ms. Jayapal, Mr. Khanna, Ms. Norton, Ms. Ocasio-Cortez, Ms. Schakowsky, Mr. Takano, Mr. Thanedar, Ms. Tlaib, and Ms. Omar) introduced the following bill; which was 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
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.
Section 1. Establishing requirements with respect to average monthly cost to provide coverage under Medicare Advantage plans
Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph:
(6) Requirement on average monthly cost to provide coverage
(A) In general
Beginning with plan years beginning on or after the date that is 1 year after the date of the enactment of this paragraph, if the Secretary determines that, with respect to a plan year and a Medicare advantage plan, the average monthly payment amount under section 1853 with respect to coverage of individuals enrolled in such Medicare Advantage plan for such plan year exceeds the average monthly cost to provide coverage for individuals enrolled in the original Medicare fee-for-service program under parts A and B for such plan year, the Secretary shall not permit any individual to enroll or reenroll in such plan for the plan year immediately following such plan year.
(B) Exception
Subparagraph (A) shall not apply with respect to a specialized MA plan for special needs individuals.