April 8, 2025
Mr. Smucker (for himself, Mr. Bilirakis, Mrs. Houchin, Mr. Thompson of California, Ms. Craig, and Mr. Norcross) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, 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
To amend part B of title XVIII of the Social Security Act to provide for a special enrollment period under Medicare for individuals enrolled in COBRA continuation coverage, and for other purposes.
Section 1. Short title
This Act may be cited as the Medicare Enrollment Protection Act of 2025
.
Sec. 2. Treatment under Medicare of individuals transitioning from COBRA continuation coverage
(a) Special enrollment period for individuals enrolled in COBRA continuation coverage
Section 1837(i) of the Social Security Act (42 U.S.C. 1395p(i)) is amended by adding at the end the following new paragraph:
(5)
(A)
In the case of an individual who—
(i)
at the time the individual first satisfies paragraph (1) or (2) of section 1836(a), is enrolled in COBRA continuation coverage (as defined in subparagraph (D)); or
(ii)
is enrolled in COBRA continuation coverage and immediately prior to such enrollment was an individual described in paragraph (1) or (2) of this subsection,
there shall be a special enrollment period described in subparagraph (B).
(B)
The special enrollment period referred to in subparagraph (A) is the period that includes—
(i)
each month during any part of which the individual is enrolled in COBRA continuation coverage; and
(ii)
the 3-month period beginning with the first month following the last month during any part of which such individual is so enrolled.
(C)
An individual may only enroll during the special enrollment period provided under subparagraph (A) one time during the individual’s lifetime.
(D)
For purposes of this paragraph, the term COBRA continuation coverage means continuation coverage beginning on or after January 1, 2026—
(i)
under a COBRA continuation provision (as defined in section 2791(d)(4) of the Public Health Service Act);
(ii)
pursuant to section 8905a of title 5, United States Code; or
(iii)
under a similar State law that provides comparable continuation of group health plan coverage.
(b) Coverage period for certain eligible individuals
Section 1838(e) of the Social Security Act (42 U.S.C. 1395q(e)) is amended—
(1)
by striking pursuant to section 1837(i)(3) or 1837(i)(4)(B)
and inserting the following:
pursuant to—
(1)
section 1837(i)(3) or 1837(i)(4)(B)—;
(2)
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively, and moving the indentation of each such subparagraph 2 ems to the right;
(3)
by striking the period at the end of subparagraph (B), as so redesignated, and inserting ; or
; and
(4)
by adding at the end the following new paragraph:
(2)
section 1837(i)(5), the coverage period shall begin on the first day of the month following the month in which the individual so enrolls.
(c) No increase in premium
Section 1839(b) of such Act (42 U.S.C. 1395r(b)) is amended—
(1)
in the first sentence, by inserting , (i)(5)
after subsection (i)(4)
;
(2)
in the second sentence, by inserting before the period at the end the following: or months for which the individual can demonstrate that the individual was enrolled in COBRA continuation coverage (as such term is defined in section 1837(i)(5)(D))
.
(d) Coordination of benefits
(1) ERISA
Section 607 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1167) is amended by adding at the end the following new paragraph:
(6) Coordination of benefits
Notwithstanding any other provision of law, in the case that an individual is enrolled in COBRA continuation coverage (as defined in section 1837(i)(5)(D) of the Social Security Act) and the individual is eligible for but not enrolled in coverage under part B of title XVIII of the Social Security Act, such COBRA continuation coverage shall not reduce or terminate benefits under such COBRA continuation coverage with respect to the individual on the basis that the individual is eligible for coverage under such part B or otherwise take into account such eligibility. Such benefits under such COBRA continuation coverage shall be provided to such an individual as if such individual were not so eligible for coverage under such part B. Nothing in the preceding two sentences shall require the provision of such COBRA continuation coverage to an individual enrolled in coverage under such part B or prohibit the termination of such continuation coverage or reduction of benefits under such continuation coverage in the case of an individual who enrolls under such part B.
(2) PHSA
Section 2208 of the Public Health Service Act (42 U.S.C. 300bb–8) is amended—
(A)
by striking Definitions
and inserting Definitions and special rules
; and
(B)
by adding at the end the following new paragraph:
(5) Special rule for coordination of benefits
Notwithstanding any other provision of law, in the case that an individual is enrolled in COBRA continuation coverage (as defined in section 1837(i)(5)(D) of the Social Security Act) and the individual is eligible for but not enrolled in coverage under part B of title XVIII of the Social Security Act, such COBRA continuation coverage shall not reduce or terminate benefits under such COBRA continuation coverage with respect to the individual on the basis that the individual is eligible for coverage under such part B or otherwise take into account such eligibility. Such benefits under such COBRA continuation coverage shall be provided to such an individual as if such individual were not so eligible for coverage under such part B. Nothing in the preceding two sentences shall require the provision of such COBRA continuation coverage to an individual enrolled in coverage under such part B or prohibit the termination of such continuation coverage or reduction of benefits under such continuation coverage in the case of an individual who enrolls under such part B.
(3) IRC
Section 4980B(g) of the Internal Revenue Code of 1986 is amended—
(A)
by striking Definitions
and inserting Definitions and special rules
; and
(B)
by adding at the end the following new paragraph:
(5) Special rule for coordination of benefits
Notwithstanding any other provision of law, in the case that an individual is enrolled in COBRA continuation coverage (as defined in section 1837(i)(5)(D) of the Social Security Act) and the individual is eligible for but not enrolled in coverage under part B of title XVIII of the Social Security Act, such COBRA continuation coverage shall not reduce or terminate benefits under such COBRA continuation coverage with respect to the individual on the basis that the individual is eligible for coverage under such part B or otherwise take into account such eligibility. Such benefits under such COBRA continuation coverage shall be provided to such an individual as if such individual were not so eligible for coverage under such part B. Nothing in the preceding two sentences shall require the provision of such COBRA continuation coverage to an individual enrolled in coverage under such part B or prohibit the termination of such continuation coverage or reduction of benefits under such continuation coverage in the case of an individual who enrolls under such part B.
(e) Updating COBRA continuation coverage notifications
Not later than January 1, 2026, the Secretary of Labor, in consultation with the Secretary of Health and Human Services, shall update the written notices required under section 606 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1166) to include an explanation of the full scope of the Medicare secondary payer rules under section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)), including how such rules apply with respect to COBRA continuation coverage (as defined in section 1837(i)(5)(D) of the Social Security Act (42 U.S.C. 1395p(i)(5)(D))).