The Close the Medigap Act of 2025 mandates guaranteed-issue protections, prohibits discriminatory pricing, increases transparency in broker payments, and improves consumer access to Medicare supplemental insurance information.
Lloyd Doggett
Representative
TX-37
The Close the Medigap Act of 2025 aims to improve consumer protections and transparency for Medicare supplemental insurance. The bill establishes national guaranteed-issue rights, prohibits discriminatory pricing based on health status or age, and restores access to first-dollar coverage plans. Additionally, it enhances the Medicare plan finder website and mandates new reporting requirements for broker compensation to ensure greater accountability in the Medigap market.
Medicare Update Mandates Guaranteed Medigap Coverage Regardless of Health History Starting 2026
The Close the Medigap Act of 2025 is a major overhaul of how supplemental insurance works for seniors and people with disabilities. Starting January 1, 2026, insurance companies will no longer be allowed to deny you a Medigap policy or charge you more just because you have a pre-existing condition, a history of health claims, or a specific medical condition. Currently, in many states, if you miss your initial enrollment window, insurers can treat you like a 'high risk' and either price you out or reject you entirely. This bill effectively ends that 'medical underwriting' for most people, ensuring that if you have Medicare Part A and B, you can get supplemental coverage at a fair price whenever you need it.
Ending the 'Pre-Existing' Penalty
Under Section 2 of the bill, the days of being penalized for your health history are numbered. Insurers are prohibited from using your genetic info or past medical visits to hike your premiums or exclude specific benefits. Imagine a retired construction worker who didn't buy Medigap right away because he was healthy, but five years later develops a heart condition. Under this bill, he could jump into a plan without being charged a 'sick tax' or facing a waiting period for his heart treatments. There is a catch, though: if you have an 'actual manifestation' of a disease, insurers might still be able to adjust individual premiums, and those qualifying for Medicare solely due to End-Stage Renal Disease don't get these same guaranteed-issue protections.
Pricing and the 'First-Dollar' Comeback
The bill also takes a swing at age-based pricing and geographic games. Section 4 bans insurers from charging different premiums based solely on how old you are, which helps stop the 'attained-age' pricing model where your bill climbs every single birthday. It also forces geographic consistency, meaning they can't slice and dice rates by neighborhood; if they change the price, it has to be for the whole county. Perhaps most notably for your wallet, Section 6 brings back 'first-dollar' coverage. This means insurers can once again sell plans that cover your Part B deductible from the very first cent, eliminating that out-of-pocket hurdle at the doctor's office.
Transparency and the Tech Upgrade
To make sure you aren't being steered toward a plan just because it pays a broker a fat commission, Section 7 requires insurance companies to publicly report exactly how much they’re paying agents and brokers. It’s like a sunshine law for insurance sales. At the same time, the government is required to beef up the Medicare Plan Finder website. By 2026, the site has to include easy-to-understand comparisons of out-of-pocket costs, inflation rates for different policies, and even ratings on how financially stable the insurance companies actually are. It’s designed to move the experience from 'confusing pile of paperwork' to something more like a modern comparison-shopping site.