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HR 6112
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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.

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.

Introduced Nov 18, 2025

Latest action (Nov 18, 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.

Referred to
Energy and Commerce Committee Ways and Means Committee
Policy area
Health
Issues
Healthcare

Summary

This bill would amend Medicare law to establish a requirement that if the average monthly payment for a Medicare Advantage plan exceeds the average monthly cost of original Medicare (Parts A and B) for the same plan year, the Secretary of Health and Human Services would be prohibited from allowing new enrollments or reenrollments in that plan for the following plan year. The requirement would begin applying to plan years starting one year after the bill's enactment. Specialized Medicare Advantage plans for special needs individuals would be exempt from this requirement.

AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.

Sponsor (1)
15 cosponsors

Actions (2)
  1. Nov 18, 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. · house
  2. Nov 18, 2025 Introduced in House

Similar bills (6)

Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.

  • HR 6113 — 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. · Introduced Nov 18, 2025 · Cong. 119 80%
  • HR 6109 — To amend title XVIII of the Social Security Act to establish certain requirements with respect to rates of reversed prior authorization coverage determinations under Medicare Advantage plans. · Introduced Nov 18, 2025 · Cong. 119 75%
  • HR 7803 — Save Medicare Act · Introduced Mar 4, 2026 · Cong. 119 74%
  • HR 6110 — To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage. · Introduced Nov 18, 2025 · Cong. 119 72%
  • S 1816 — Improving Seniors’ Timely Access to Care Act of 2025 · Introduced May 20, 2025 · Cong. 119 71%
  • HR 3665 — Medicare Economic Security Solutions Act · Introduced May 29, 2025 · Cong. 119 70%

Text versions (1)
  • Introduced in House · Nov 18, 2025

Only one text version is on file, so there’s no earlier version to compare against yet.

Full text

IN THE HOUSE OF REPRESENTATIVES

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

A BILL

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.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

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.”. <all>

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