SEC. 1171. LIMITATION ON COST-SHARING FOR INDIVIDUAL HEALTH SERVICES.

[a] In General- Section- 1852[a][1] of the Social Security Act [42 U.S.C. 1395w-22[a][1]] is amended--

[1] in subparagraph [A], by inserting before the period at the end the following: 'with cost-sharing that is no greater [and may be less] than the cost-sharing that would otherwise be imposed under such program option';

[2] in subparagraph [B][i], by striking 'or an actuarially equivalent level of cost-sharing as determined in this part'; and

[3] by amending clause [ii] of subparagraph [B] to read as follows:

'[ii] PERMITTING USE OF FLAT COPAYMENT OR PER DIEM RATE- Nothing in clause [i] shall be construed as prohibiting a Medicare Advantage plan from using a flat copayment or per diem rate, in lieu of the cost-sharing that would be imposed under part A or B, so long as the amount of the cost-sharing imposed does not exceed the amount of the cost-sharing that would be imposed under the respective part if the individual were not enrolled in a plan under this part.'.

[b] Limitation for Dual Eligibles and Qualified Medicare Beneficiaries- Section- 1852[a] of such Act is amended by adding at the end the following new paragraph:

'[7] LIMITATION ON COST-SHARING FOR DUAL ELIGIBLES AND QUALIFIED MEDICARE BENEFICIARIES- In the case of a individual who is a full-benefit dual eligible individual [as defined in section 1935[c][6]] or a qualified medicare beneficiary [as defined in section 1905[p][1]] who is enrolled in a Medicare Advantage plan, the plan may not impose cost-sharing that exceeds the amount of cost-sharing that would be permitted with respect to the individual under this title and title XIX if the individual were not enrolled with such plan.'.

[c] Effective Dates-

[1] The amendments made by subsection [a] shall apply to plan years beginning on or after January 1, 2011.

[2] The amendments made by subsection [b] shall apply to plan years beginning on or after January 1, 2011.