Medicare Advantage MLR Transparency Act
Summary
What This Bill Does
The Medicare Advantage MLR Transparency Act would add plan-level public financial disclosures to Medicare Advantage contracts. Beginning with plan years on or after January 1, 2029, every Medicare Advantage organization would have to submit specified information to HHS and publish it on the organization's public website for each plan it offers. HHS would specify a consumer-friendly presentation format.
For each plan, the organization would disclose total revenue; the amount and percentage spent on incurred claims; the amount and percentage spent on non-claims costs; the dollar difference between the regulatory medical-loss-ratio numerator and denominator; and that difference as a percentage of plan revenue. The calculations would use existing Medicare Advantage regulatory definitions, treated at the individual-plan and plan-year level rather than only at the contract level.
HHS could also require the same information in an aggregate format, such as across all Medicare Advantage plans offered by an organization. Separately, electronic comparative plan information furnished after the first plan year beginning at least one year after enactment would, to the greatest extent practicable, use the same uniform format applicable to summaries furnished by group health plans and health insurers under section 2715 of the Public Health Service Act.
The bill does not change the existing medical-loss-ratio threshold, redefine which costs qualify as claims or quality improvement, order a rebate, alter Medicare Advantage payment rates, create a new civil penalty, or appropriate implementation funds. Its direct policy change is public and governmental reporting in a standardized format.
Who Benefits and How
Medicare beneficiaries comparing plan options gain access to plan-specific information about how much revenue supports claims and how much goes to non-claims costs. Current enrollees, consumer advocates, researchers, journalists, and Medicare oversight officials can compare plans and organizations with more granular public data. Plans with relatively high claims spending or low overhead may gain a competitive or reputational advantage from the standardized disclosures.
Who Bears the Burden and How
Medicare Advantage organizations must calculate, validate, submit, and publish each required metric for every plan and may also have to produce organization-wide aggregates. Insurers must redesign public websites and electronic comparison materials to comply with CMS formats, creating data, legal-review, technology, and reporting costs. Plans with high non-claims spending face greater reputational and competitive exposure. CMS must define consumer-friendly and aggregate formats, receive the data, and monitor contract compliance without a new appropriation in the bill.
Key Provisions
- Requires plan-level Medicare Advantage financial disclosure beginning in 2029.
- Requires publication of revenue, claims, non-claims, and MLR-gap amounts and percentages.
- Directs insurers to submit the same information to HHS.
- Authorizes HHS to require organization-level aggregate reporting.
- Applies existing MLR regulatory definitions at the plan and plan-year level.
- Requires more uniform electronic comparative plan information after at least one year.
- Leaves existing MLR thresholds, payments, and penalties unchanged.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Require Medicare Advantage organizations to disclose plan-level revenue, claims, non-claims costs, and medical-loss-ratio gap information publicly in a consumer-friendly format and make electronic plan information more uniform.
Key Policy Areas
Medicare Advantage, Health Insurance, Consumer Transparency, Medical Loss Ratios
Primary Purpose
Require Medicare Advantage organizations to disclose plan-level revenue, claims, non-claims costs, and medical-loss-ratio gap information publicly in a consumer-friendly format and make electronic plan information more uniform.
Policy Domains
Section 2 - Medicare Advantage financial and format transparency
Identified Gains
- Medicare beneficiaries comparing plan financial information
- Current Medicare Advantage enrollees monitoring their plans
- Consumer advocates reviewing Medicare Advantage overhead
- Health policy researchers using plan-level MLR data
- Medicare oversight officials reviewing plan spending
Identified Costs
- Medicare Advantage organizations producing plan-level disclosures
- Insurance compliance staff validating MLR figures
- Health insurance technology teams changing public websites
- Plans exposed to competition over non-claims spending
- CMS administrators specifying and monitoring disclosure formats
Legislative Progress
ReportedOrdered to be Reported in the Nature of a Substitute …
Committee Consideration and Mark-up Session Held
Mr. Moran introduced the following bill; which was referred to …
Referred to the Committee on Ways and Means, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Consumer advocates reviewing Medicare Advantage overhead, Medicare Advantage organizations producing plan disclosures, Plans exposed to competition over non-claims spending
Positive-direction: Consumer advocates reviewing Medicare Advantage overhead
Negative-direction: Medicare Advantage organizations producing plan disclosures, Plans exposed to competition over non-claims spending
Medicare beneficiaries comparing plan financial information
Health policy researchers using plan-level MLR data
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "hhs"
- → Secretary of Health and Human Services and CMS
- "plans"
- → Individual Medicare Advantage plans
- "researchers"
- → Consumer advocates and health policy researchers
- "beneficiaries"
- → Medicare beneficiaries comparing or enrolled in plans
- "organizations"
- → Medicare Advantage organizations
Note: {'scope_ids': ['medicare_advantage_mlr_disclosure'], 'description': 'The bill increases disclosure and standardization but does not change the substantive MLR threshold, cost classifications, payment rates, rebates, or penalty structure.'}
Key Definitions
Terms defined in this bill
Revenue, incurred-claims, non-claims-cost, and MLR numerator-denominator difference amounts and percentages calculated under existing regulations for each plan year.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology