To allow eligible beneficiaries in MedicareAdvantage plans to elect zero premium, stop-loss drug coverage protection.
What it does: Inserts new text on page 343, between lines 15 and 16
Sen. Rick Santorum (R-PA)Inserts new text on page 343, between lines 15 and 16
InsertsPrinted pageInserted: (f) Zero Premium Stop-Loss Protection and Access to Negotiated Prices For Eligible Beneficiaries Enrolled in MedicareAdvantage Plans.--
Inserted: (1) In general.--Notwithstanding any provision of this part or part D, a MedicareAdvantage plan shall be treated as meeting the requirements of this section if, in lieu of the qualified prescription drug coverage otherwise required, the plan makes available such coverage with the following modifications:
Inserted: (A) No premium.--Notwithstanding subsection (d) or sections 1860D-13(e)(2) and 1860D-17, the amount of the MedicareAdvantage monthly beneficiary obligation for qualified prescription drug coverage shall be zero.
Inserted: (B) Beneficiary receives access to negotiated prices and stop-loss protection for no additional premium.--Notwithstanding section 1860D-6, qualified prescription drug coverage shall include coverage of covered drugs that meets the following requirements:
Inserted: (i) The coverage has cost-sharing (for costs up to the annual out-of-pocket limit under subsection (c)(4) of such section) that is equal to 100 percent.
Inserted: (ii) The coverage provides the limitation on out-of-pocket expenditures under such subsection (c)(4), except that in applying such subsection, '$__' shall be substituted for '$3,700' in subparagraph (B)(i)(I) of such subsection.
Inserted: (iii) The coverage provides access to negotiated prices under subsection (e) of such section during the entire year.
Inserted: (C) Application of low-income subsidies.--Notwithstanding subsection (f) or section 1860D-19, the Administrator shall not apply the following provisions of subsection (a) of such section:
Inserted: (i) Subparagraphs (A), (B), (C), and (D) of paragraph (1).
Inserted: (ii) Subparagraphs (A), (B), (C), and (D) of paragraph (2).
Inserted: (iii) Clauses (i), (ii), (iii), and (iv) of paragraph (3)(A).
Inserted: (2) Penalty for enrolling in a zero premium stop-loss protection plans after initial eligibility for such enrollment.--In the case of an eligible beneficiary that enrolled in a plan offered pursuant to this subsection at any time after the initial enrollment period described in section 1860D-2, the Secretary shall establish procedures for imposing a monthly beneficiary obligation for enrollment under such plan. The amount of such obligation shall be an amount that the Administrator determines is actuarially sound for each full 12-month period (in the same continuous period of eligibility) in which the eligible beneficiary could have been enrolled under such a plan but was not so enrolled. The provisions of subsection (b) of such section shall apply to the penalty under this paragraph in a manner that is similar to the manner such provisions apply to the penalty under part D.
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Inserted: (3) Procedures.--The Administrator shall establish procedures to carry out this subsection. Under such procedures, the Administrator may waive or modify any of the preceding provisions of this part or part D to the extent necessary to carry out this subsection.
Inserted: (4) No effect on medicare drug plans.--This subsection shall have no effect on eligible beneficiaries enrolled under part D in a Medicare Prescription Drug plan or under a contract under section 1860D-13(e).
Original wording
On page 343, between lines 15 and 16, insert the following:
Read automatically from the Congressional Record. Check the original before relying on it.
As printed
SA 1132. Mr. SANTORUM proposed an amendment to the bill S. 1, to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the Medicare program and to strengthen and improve the Medicare program and for other purposes; as follows:
On page 343, between lines 15 and 16, insert the following:
“(f) Zero Premium Stop-Loss Protection and Access to Negotiated Prices For Eligible Beneficiaries Enrolled in MedicareAdvantage Plans.--
“(1) In general.--Notwithstanding any provision of this part or part D, a MedicareAdvantage plan shall be treated as meeting the requirements of this section if, in lieu of the qualified prescription drug coverage otherwise required, the plan makes available such coverage with the following modifications:
“(A) No premium.--Notwithstanding subsection (d) or sections 1860D-13(e)(2) and 1860D-17, the amount of the MedicareAdvantage monthly beneficiary obligation for qualified prescription drug coverage shall be zero.
“(B) Beneficiary receives access to negotiated prices and stop-loss protection for no additional premium.--Notwithstanding section 1860D-6, qualified prescription drug coverage shall include coverage of covered drugs that meets the following requirements:
“(i) The coverage has cost-sharing (for costs up to the annual out-of-pocket limit under subsection (c)(4) of such section) that is equal to 100 percent.
“(ii) The coverage provides the limitation on out-of-pocket expenditures under such subsection (c)(4), except that in applying such subsection, ‘$__' shall be substituted for ‘$3,700' in subparagraph (B)(i)(I) of such subsection.
“(iii) The coverage provides access to negotiated prices under subsection (e) of such section during the entire year.
“(C) Application of low-income subsidies.--Notwithstanding subsection (f) or section 1860D-19, the Administrator shall not apply the following provisions of subsection (a) of such section:
“(i) Subparagraphs (A), (B), (C), and (D) of paragraph (1).
“(ii) Subparagraphs (A), (B), (C), and (D) of paragraph (2).
“(iii) Clauses (i), (ii), (iii), and (iv) of paragraph (3)(A).
“(2) Penalty for enrolling in a zero premium stop-loss protection plans after initial eligibility for such enrollment.--In the case of an eligible beneficiary that enrolled in a plan offered pursuant to this subsection at any time after the initial enrollment period described in section 1860D-2, the Secretary shall establish procedures for imposing a monthly beneficiary obligation for enrollment under such plan. The amount of such obligation shall be an amount that the Administrator determines is actuarially sound for each full 12-month period (in the same continuous period of eligibility) in which the eligible beneficiary could have been enrolled under such a plan but was not so enrolled. The provisions of subsection (b) of such section shall apply to the penalty under this paragraph in a manner that is similar to the manner such provisions apply to the penalty under part D.
“(3) Procedures.--The Administrator shall establish procedures to carry out this subsection. Under such procedures, the Administrator may waive or modify any of the preceding provisions of this part or part D to the extent necessary to carry out this subsection.
“(4) No effect on medicare drug plans.--This subsection shall have no effect on eligible beneficiaries enrolled under part D in a Medicare Prescription Drug plan or under a contract under section 1860D-13(e).”
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Senate amendment submitted
June 26, 2003
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Senate amendment submitted
June 26, 2003
Senate amendment proposed (on the floor): Amendment SA 1132 proposed by Senator Santorum.(consideration: CR S8679-8680; text: CR S8679)
June 26, 2003
Amendment SA 1132 proposed by Senator Santorum. (consideration: CR S8679-8680; text: CR S8679) To allow eligible beneficiaries in MedicareAdvantage plans to elect zero premium, stop-loss drug coverage protection.
June 26, 2003
Proposed amendment SA 1132 withdrawn in Senate.
June 26, 2003