Sec. 3. Medicare flex fund accounts under Medicare Advantage

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Section 1851 of the Social Security Act ( 42 U.S.C. 1395w–21 ) is amended by adding at the end the following new subsection: Notwithstanding any other provision of law and subject to paragraph (4), any MA plan offered under this part (other than an MSA plan) shall establish a Medicare flex fund account (as defined in section 530A of the Internal Revenue Code of 1986 and referred to in this subsection as a Medicare FFA ) on behalf of an enrollee in the plan. In the case of a plan that is required to provide a monthly rebate to an enrollee under section 1854(b)(1)(C), the MA plan may provide part or all of such rebate through depositing money into the enrollee's Medicare FFA.

Notwithstanding section 1851(h)(4)(A) or any other provision of this part and subject to subparagraph (B), MA plans may deposit money into an enrollee's Medicare FFA as a result of the enrollee completing educational or training programs, programs for chronic disease management, programs that promote wellness and health, or other programs as determined by the Secretary. In making the deposits described in subparagraph (A), the following rules shall apply: No payment shall be made to an MA organization under this part as a result of such deposits.

In submitting bid information required under section 1854, the MA organization offering the MA plan shall not take into account such deposits. The MA plan may not charge a premium or otherwise increase a premium under section 1854 as a result of such deposits. Subject to subparagraph (B), for the first 3 years a Medicare FFA is established pursuant to paragraph

(1)with respect to an enrollee, each MA plan shall deposit no less than $400 each year into the enrollee's Medicare FFA. The rebates described in paragraph

(2)and incentive payments described in paragraph

(3)shall count towards the required minimum deposit amount described in subparagraph (A). An enrollee may not spend any amount in a Medicare FFA on a premium for a medicare supplemental policy under section 1882. The Secretary may waive the requirement described in paragraph

(1)for— a specialized MA plan for special needs individuals; an employer sponsored MA plan described in section 1857(i)(2); and an MA plan in which an enrollee in such plan already has a Medicare FFA if the study required by section 3(b) of the Medicare Flex Fund Accounts and Flexible Benefits Act of 2024 concludes that it is feasible to permit Medicare beneficiaries enrolled in an MA plan to select their preferred Medicare FFA band under the plan. Notwithstanding subparagraph (A), an MA plan described in such subparagraph shall establish a Medicare FFA if an enrollee in such plan elects to have a Medicare FFA established on behalf of the enrollee. The Secretary shall include information regarding Medicare FFAs in relevant education materials, including— the notice required under section 1804(a) (commonly referred to as the Medicare & You handbook); any site-of-service transparency information made available to the public under section 1834(t); any information provided to individuals regarding coverage options under section 1851(d); and in consultation with the Secretary of the Treasury, additional general beneficiary educational material regarding this title and this part. . The amendment made by paragraph

(1)shall apply to plan years beginning on or after January 1, 2026. The Secretary of Health and Human Services (in this subsection referred to as the Secretary ) shall conduct a study on the feasibility of permitting Medicare beneficiaries enrolled in a Medicare Advantage plan under part C of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–21 et seq. ) to select their preferred Medicare flex fund account (as described in section 1851(k) of such Act ( 42 U.S.C. 1395w–21(k) )) bank under the plan. Such study shall include an analysis of any administrative actions that the Secretary may take in order to permit such beneficiaries to make such selection. Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under paragraph (1), together with— a description of any administrative actions described in paragraph

(1)that the Secretary has taken, or plans to take; and recommendations for such legislation as the Secretary determines appropriate. The Secretary of Health and Human Services (in this subsection referred to as the Secretary ), shall conduct a study on the feasibility of permitting Medicare beneficiaries enrolled in a Medicare Advantage plan under part C of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–21 et seq. ) to select their preferred supplemental health benefits under such plan and have the savings from unused benefits deposited into the Medicare flex fund account (as described in section 1851(k) of such Act ( 42 U.S.C. 1395w–21(k) )) of the enrollee. Such study shall include an analysis of any administrative actions that the Secretary may take in order to permit such beneficiaries to make such selection. In carrying out the study under paragraph (1), the Secretary shall conduct public meetings and consult with Medicare Advantage plans, actuaries, and health think tanks. Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress a report on the study conducted under paragraph (1), together with— a description of any administrative actions described in paragraph

(1)that the Secretary has taken, or plans to take; and recommendations for such legislation as the Secretary determines appropriate.

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42 USC 1395w–21
42 USC 1395w–21(k)

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Sec. 3

Medicare flex fund accounts under Medicare Advantage

Cite42 USC 1395w–21

Cite42 USC 1395w–21(k)

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