HR4093-119

What This Bill Does

This bill requires the federal government to publish detailed, transparent information comparing Medicare spending for people in traditional Medicare versus those in Medicare Advantage private plans. It mandates that the Secretary of Health and Human Services publish expenditure data broken down by geographic area, enrollment type, and coverage categories, while also requiring the Medicare Payment Advisory Commission (MedPAC) to analyze whether Medicare Advantage plans are actually saving money compared to traditional Medicare.

Who Benefits and How

• Medicare beneficiaries and taxpayers benefit from increased transparency about how Medicare funds are spent across different plan types, enabling better-informed decisions about their coverage options.
• Healthcare policy researchers and watchdog groups gain access to detailed, machine-readable expenditure data that allows independent analysis of Medicare spending patterns and program efficiency.
• Critics of Medicare Advantage overpayments benefit because the required MedPAC analyses could expose whether private Medicare Advantage plans are actually costing taxpayers more than traditional Medicare for similar populations.

Who Bears the Burden and How

• The Centers for Medicare & Medicaid Services (CMS) must create and maintain new data publication systems, producing machine-readable expenditure reports broken down by 30+ categories of beneficiaries, geographic areas, and coverage combinations.
• Medicare Trustees face new requirements to disaggregate and publish expenditure data across multiple beneficiary categories as part of their annual reports.
• MedPAC must conduct annual retrospective analyses comparing Medicare Advantage and traditional Medicare costs, including making methodology public for comment and responding to all feedback.

Key Provisions

• Requires CMS to publish Medicare expenditure data by county and Metropolitan Statistical Area in machine-readable format, beginning in 2025
• Mandates expenditure reporting across approximately 35 different categories of beneficiaries based on their Part A, Part B, Part C (Medicare Advantage), and Part D enrollment status
• Requires MedPAC to publish annual analyses comparing average expenditures for Medicare Advantage enrollees versus traditional Medicare beneficiaries
• Mandates that MedPAC make all data and methodology public for replication and comment before finalizing reports
• Requires the Medicare Trustees to include disaggregated expenditure information in their annual reports starting in 2026