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No Medicare Clawbacks Act of 2026
To amend title XVIII of the Social Security Act to prohibit group health plan payment clawbacks in certain circumstances.
Summary
- Prohibits group health plans from recouping payments they initially made for items or services when the individual becomes eligible for Medicare benefits, under certain conditions.
- The prohibition applies when a group health plan made payment for an item or service without considering the individual's Medicare eligibility.
- The protection applies only if the item or service was furnished during a period of retroactive Medicare Part A coverage.
- The protection also requires that the individual was not behind on employee contributions to the group health plan at the time the service was furnished.
- Adds penalties for group health plans that violate this prohibition against payment recoupment.
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)
1 cosponsor
Actions (2)
- Jun 29, 2026 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
- Jun 29, 2026 Introduced in House
Similar bills (6)
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Full text
IN THE HOUSE OF REPRESENTATIVES
June 29, 2026
Mr. Torres of New York (for himself and Ms. Clarke of New York) 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 prohibit group health plan payment clawbacks in certain circumstances.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “No Medicare Clawbacks Act of 2026”.
SEC. 2. PROHIBITING GROUP HEALTH PLAN PAYMENT CLAWBACKS IN CERTAIN CIRCUMSTANCES.
Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is amended—
(1) in paragraph (1)(A)(ii)—
(A) by striking “Clause (i)” and inserting the following:
“(I) In general.—Clause (i)”; and
(B) by adding at the end the following new subclause:
“(II) Prohibition on payment clawbacks in certain circumstances.—In the case of an item or service furnished to an individual entitled to benefits under this title under section 226(a) who is also enrolled in a group health plan, if clause (i) would otherwise apply to such individual and plan but for application of subclause
(I) and if such plan initially makes payment for such item or service without regard to such entitlement, such plan may not later recoup such payment, in whole or part, on the basis that such individual was so entitled to such benefits, provided that— “(aa) such item or service was furnished during a period of retroactive coverage of part A benefits applicable to such individual; and “(bb) at the time such item or service was furnished, such individual was not behind on any employee contribution owed by such individual with respect to enrollment in such plan.”; and
(2) in paragraph (3)(A), by inserting “or in the case of a group health plan that recoups payment in violation of paragraph (1)(A)(ii)(II)” before the period. <all>
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