The RAMP Act clarifies the private right of action for individuals to sue group health plans that fail to make primary payments or provide appropriate reimbursement when Medicare should have paid first.
Gus Bilirakis
Representative
FL-12
The RAMP Act, or Repair Abuses of MSP Payments Act, clarifies the legal pathway for individuals to sue their group health plans. This legislation specifically allows for a private cause of action when a group health plan fails to make primary payments or provide appropriate reimbursement as required under Medicare secondary payer rules. Essentially, it updates existing law to ensure group health plans are held accountable for improper payment sequencing involving Medicare.
RAMP Act Clarifies When You Can Sue Your Health Plan Over Medicare Payment Mix-ups
The Repair Abuses of MSP Payments Act, or the RAMP Act (Sec. 1), targets a very specific, but very frustrating, problem: when your group health plan tries to make Medicare pay first, even though the plan was supposed to be the primary payer. This bill doesn’t create a new right to sue; it just cleans up the language to make sure that right is actually usable.
When the Health Plan Tries to Pass the Buck
If you have a group health plan (usually through your employer) and you’re also eligible for Medicare, there are strict rules about who pays first. These are the Medicare Secondary Payer (MSP) rules. When the group plan is supposed to pay first but doesn't, it can leave you stuck in the middle, fighting over bills. Right now, the law allows people to take legal action in these situations (Sec. 2).
However, the existing statute uses the technical term “primary plan” when describing who you can sue. The RAMP Act cuts through that jargon by replacing “primary plan” with “group health plan” in that section of the Social Security Act. This small change is a big deal for clarity. It directly targets the specific entity—the group health plan defined under paragraph (1)(A)(v)—that failed to make the primary payment or provide appropriate reimbursement.
What This Means for Your Wallet and Your Time
Think of it this way: if your group health insurer incorrectly denies a claim, forcing Medicare to pay when it shouldn't have, or if you end up paying out of pocket and the insurer drags their feet on reimbursement, this bill makes it easier to hold them accountable. The change ensures the legal system is crystal clear on which type of plan is liable for these payment failures.
For the average person, this means less time fighting bureaucracy and a clearer path to getting back the money you are owed. It strengthens the existing private cause of action, which is the legal term for your right to sue. On the flip side, group health plans (insurers) will need to be extra diligent about complying with MSP rules, as this clarification makes it easier for consumers and their lawyers to pursue litigation when those rules are broken. Essentially, the RAMP Act provides a stronger tool for people to ensure their group health plan plays by the rules when coordinating benefits with Medicare.