Sponsors (2)
The bill increases transparency and program oversight of Medicare Advantage—helping beneficiaries, researchers, and CMS—but does so by imposing new reporting requirements and privacy risks that raise costs and administrative burdens, especially for smaller plans and providers.
Medicare beneficiaries will get clearer, enrollee-level information on supplemental benefits and out-of-pocket costs, helping them understand and compare benefit use and financial burden.
Researchers, policymakers, and the public will have annual, standardized public-use data (starting 2030) to evaluate Medicare Advantage, track trends, and inform policy decisions.
CMS and program administrators will gain more detailed, NPI-linked utilization and payment data to improve oversight, detect disparities, and identify potential fraud or misuse of supplemental benefit spending.
Medicare Advantage plans will face new reporting and compliance costs to collect and submit enrollee-level data beginning in 2029, increasing administrative burdens.
Taxpayers and beneficiaries face a risk of privacy breaches if de-identification and data protections are insufficient, exposing sensitive health and payment information.
Smaller providers and small health plans may be disproportionately burdened by the administrative work required to map services to categories and append NPIs, raising relative costs for small entities.
Based on analysis of 2 sections of legislative text.
Requires MA plans to submit enrollee-level supplemental benefit data starting for plan years on/after Jan 1, 2029, with CMS publishing annual public-use files beginning in 2030.
Official title: To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.
Introduced September 10, 2025 by Jennifer McClellan · Last progress September 10, 2025
Requires Medicare Advantage plans to submit detailed enrollee-level data on supplemental benefits for plan years beginning on or after January 1, 2029, and directs the Secretary of HHS/CMS to publish deidentified public-use data files annually starting in 2030. The data must include eligibility, benefit categories and items, utilization, payments (including total spent per enrollee who used benefits), enrollee out-of-pocket cost per use, and provider identifiers, with safeguards for individually identifiable information.