“A bill to preserve patient access to health care providers and prescription drug coverage under Medicare and individual market plans.”
No CRS summary available for this bill.
This section establishes special enrollment periods under Medicare Advantage plans if a provider with whom an individual had an in-person or telehealth visit in the preceding 2 years becomes out-of-network, and under Medicare prescription drug plans and MA-PD plans if the plan implements a negative formulary change for a covered Part D drug used by the individual in the previous 6 months. It applies these changes to plan years beginning on or after January 1, 2027. It also requires health insurance issuers in the individual market to establish special enrollment periods during a plan year for the same provider network or negative formulary changes, and directs exchanges to accommodate such periods.