When someone has private health insurance that should be paying first — before Medicare picks up the tab — and that insurer refuses to pay, current law lets patients and Medicare sue to recover damages from certain types of plans but not all of them. This narrow but targeted bill fixes that gap by expanding the private right of action so that claims can be brought specifically against group health plans (the employer-sponsored kind) that fail to pay as the primary insurer. It's a change that could help Medicare recover costs that should have been covered by private insurance.
Congressional Summary
This bill restricts the private right of action against insurance plans that do not provide appropriate primary payment in cases in which Medicare is a secondary payer.Current law allows for a private right of action against primary plans that do not provide appropriate primary payment in cases in which Medicare is a secondary payer; this provision applies to group health plans, workers' compensation plans, automobile or liability insurance plans, and no-fault insurance plans. The bill limits this provision to group health plans.
Details
- Congress
- 119th
- Chamber
- Senate
- Status
- summarized
- Action
- Introduced in Senate
- Action Date
- 2026-02-10
- Date Added
- 2026-03-30
- Source
- Congress.gov →
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