HR 1339, the Safeguarding Social Security and Medicare Act, requires the Comptroller General to conduct a study within one year of enactment on how inflation and rising living costs impact Social Security and Medicare benefits. The study will examine these effects and provide Congress with specific recommendations for legislative actions to maintain full benefits for these programs. This study directly addresses the needs of 71.7 million Social Security recipients and 66.6 million Medicare beneficiaries, focusing on financial pressures faced by seniors and disabled individuals. The bill itself does not change current benefits but aims to inform future policy decisions through evidence-based analysis.
HR 1950, the Protect Social Security and Medicare Act, requires a two-thirds vote in both the House and Senate to consider any bill or amendment that would reduce Social Security or Medicare benefits administered by the Social Security Administration (SSA) or Centers for Medicare & Medicaid Services (CMS). This rule applies directly to lawmakers who would need supermajority support to advance proposals affecting these programs. An exception allows changes to Medicare Advantage plan payments if offset by increased payments elsewhere in Medicare. Determinations about whether a provision reduces benefits are made solely by the SSA's Office of the Chief Actuary during legislative consideration.
HR 2314, the FAIR Act, requires hospitals participating in Medicare-funded residency programs to annually report data on applicants and acceptances from both osteopathic (DO) and allopathic (MD) medical schools. Hospitals must publicly affirm they consider applicants from both pathways equally and accept scores from either the COMLEX (for DOs) or USMLE (for MDs) exams. Non-compliant hospitals face a 2% reduction in Medicare payments starting in 2026 for each prior year of non-reporting. The bill directly affects hospitals receiving Medicare residency funding, aiming to increase transparency in admissions without mandating specific acceptance rates or federal oversight of medical education.
Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies Act or the PREVENT DIABETES Act This bill allows health care entities to provide virtual services under the Medicare Diabetes Prevention Program for an additional three years. The Medicare Diabetes Prevention Program offers Medicare beneficiaries who are at risk of developing Type 2 diabetes specialized training and education regarding diet, exercise, and other behavioral changes. The Centers for Medicare & Medicaid Services issued temporary authorization for entities participating in the program to provide these services virtually until December 31, 2027. The bill extends the authorization for virtual services until December 31, 2030.
HR 1244, the "Reducing Drug Prices for Seniors Act," requires Medicare Part D plans to calculate coinsurance for covered drugs based on the plan's actual acquisition cost (the negotiated net price paid by the plan) rather than the drug's wholesale price, starting in 2026. This change directly affects Medicare Part D beneficiaries who pay coinsurance after meeting their deductible but before reaching the out-of-pocket threshold. The bill mandates that plans use the actual cost reported in the Detailed DIR Report, excluding certain drugs covered under specific exceptions. This policy aims to lower out-of-pocket costs for seniors by aligning coinsurance with the price the plan actually pays for medications.
HR 182, the Default Prevention Act, establishes a priority system for paying U.S. government obligations when the national debt limit is reached. It requires the Treasury to first pay Tier I obligations (including Social Security, Medicare, and interest on public debt), then Tier II (defense and veterans benefits), followed by Tier III, Tier IV (federal employee pay and travel expenses), and finally Tier V (Congressional salaries), only if higher-tier payments can still be fully covered. The bill mandates weekly reports to Congress detailing payments made and unpaid across each tier. This directly affects beneficiaries of Social Security/Medicare, veterans, defense programs, federal employees, and Congress by defining which payments must be prioritized during a debt limit crisis.
Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act This bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs. Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs.
The Close the Medigap Act of 2025 would prohibit Medigap insurance issuers from denying coverage or charging higher premiums based on health status, pre-existing conditions, genetic information, or other factors. It requires insurers to spend a minimum percentage of premiums on health care claims and improves the Medicare Plan Finder website to provide clearer information about coverage options, out-of-pocket costs, and guaranteed issue requirements. The bill applies to Medigap policies effective January 1, 2026, with full implementation by 2031, and requires Medigap brokers to disclose payments they receive from insurers. These changes would directly affect Medicare beneficiaries, particularly those with pre-existing conditions who have historically faced barriers to obtaining affordable supplemental coverage.
HR 1492 amends the Social Security Act to extend the negotiation period for standard drug manufacturers under the federal drug pricing program. Specifically, it changes the timeframe from 7 years to 11 years for small-molecule drugs (like traditional pills) to negotiate prices with the government, aligning it with the existing 12-year period for complex biologic drugs (like insulin or monoclonal antibodies). This adjustment directly affects pharmaceutical companies that produce small-molecule drugs, giving them a longer window to negotiate pricing terms. The bill makes this change effective as if it had been part of the 2022 law that established the program.
Medicare Enrollment Protection Act of 2025 This bill provides for a special enrollment period for Medicare medical benefits for individuals who are enrolled in COBRA continuation coverage at the time they qualify for Medicare. The special enrollment period applies during each month of COBRA coverage and the three-month period after coverage ends; individuals may enroll during the special enrollment period once during their lifetime.
