Medicare beneficiaries gain shield against surprise health plan clawbacks
H.R. 9532 — No Medicare Clawbacks Act of 2026 · Filed by Ritchie Torres (D-NY) · 1 cosponsor · Introduced Jun 29, 2026 · Referred to committee
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What it does
This bill amends Medicare law to prohibit group health plans from clawing back (reclaiming) payments they initially made for medical services when those services were furnished during a period when a beneficiary had retroactive Medicare Part A coverage, provided the beneficiary was current on their employee contributions to the group plan. The bill protects individuals from being billed twice—once by the group plan and again when Medicare retroactively covers the same service.
Why we flagged it
The bill is a narrow protective measure addressing a specific administrative problem—retroactive clawbacks by group health plans—that affects working-age Medicare beneficiaries. It does not create new entitlements or broad policy shifts; it constrains a plan practice that creates billing confusion.
What the text implies
- The bill applies only when retroactive Part A coverage is involved and the beneficiary is current on contributions, creating a narrow safe harbor that may not cover all clawback scenarios beneficiaries face.
- Group health plans may respond by tightening coordination-of-benefits procedures upfront, potentially delaying initial payments or requiring beneficiaries to prove Medicare eligibility status before plan payment.
The full analysis lists 3 implications of this text.
Who stands to gain
working-age Medicare beneficiaries; individuals with dual coverage (group health plan + Medicare Part A)