GAP Act
- Sponsor
- Rep. Davids, Sharice [D-KS-3]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Oct 5, 2026
Bottom line
The GAP Act aims to expand access to Medigap plans for Medicare beneficiaries by creating a guaranteed issue annual enrollment period, potentially increasing costs for insurers and premiums for healthier enrollees.
What it actually does
This bill, known as the GAP Act, amends the Social Security Act to establish an annual enrollment period for Medicare supplemental (Medigap) policies, beginning January 1, 2028. During this period, which aligns with the Medicare Advantage annual election period, Medigap insurers would be prohibited from denying coverage, conditioning issuance, or discriminating in pricing based on an individual's health status, claims experience, or medical condition.
Proponents argue
Supporters argue this bill provides crucial consumer protections, allowing more seniors to switch or enroll in Medigap plans regardless of pre-existing conditions. They contend it fosters competition and ensures continuous access to comprehensive supplemental coverage, preventing beneficiaries from being locked into inadequate plans due to health changes.
Opponents contend
Opponents might argue that mandating guaranteed issue without corresponding risk adjustment mechanisms could lead to adverse selection, where sicker individuals disproportionately enroll. This could drive up premiums for healthier individuals and potentially destabilize the Medigap market, making plans less affordable for those currently enrolled.
The bill text is extremely short and easy to read, making it highly accessible for any reader to understand its provisions.
Section 2(a)
Establishes Annual Guaranteed Issue Enrollment Period for Medigap
This provision amends Section 1882 of the Social Security Act to create a yearly enrollment period for Medicare supplemental (Medigap) policies, starting January 1, 2028. This period will coincide with the existing annual coordinated election period for Medicare Advantage plans. During this time, Medigap insurers are prohibited from denying coverage, conditioning issuance, or discriminating in pricing based on an individual's health status, claims history, or medical condition.
Supporters argue
Supporters argue this provision ensures that all Medicare beneficiaries, regardless of their health status, have a fair opportunity to obtain or switch Medigap coverage annually, preventing 'lock-in' effects and providing peace of mind and financial security.
Critics contend
Critics contend that mandating guaranteed issue without corresponding risk adjustment mechanisms could lead to adverse selection, where sicker individuals disproportionately enroll, driving up premiums for healthier enrollees and potentially making Medigap unaffordable for many.
Tradeoffs
The provision balances the goal of universal access and consumer protection against the potential for market destabilization and increased costs for healthier individuals within the Medigap risk pool.
Section 2(b)
Medicare Outreach Program Update
This section directs the Secretary of Health and Human Services to update existing Medicare outreach materials, specifically the 'Medicare & You' and 'Welcome to Medicare' notices, within 30 days of the bill's enactment. The updates must include information about the new annual enrollment period for Medigap policies established by this Act.