To amend title XVIII to reform the Medicare Advantage program.

House Votes

This bill would make big changes to Medicare Advantage starting in 2028. Plans would mostly have to pay for care using a fixed monthly amount per person, instead of paying for each service. Some existing plans and special needs plans could be exceptions. It would also change how the government measures patients’ health for paying plans: only diagnoses from in‑person or telehealth visits would count, not from chart reviews or stand‑alone health risk surveys, and it would look back two years. Some extra payment increases tied to quality scores would end. The government could set up a “stop‑loss” safety net to help plans with unusually high costs, based on audited data, without raising total spending overall.

People who have Medicare Part A and Part B would be automatically enrolled in the lowest‑premium Medicare Advantage plan in their area, but they could opt out. If someone enrolls in a plan, they would generally need to stay in it for three years, unless they have a hardship, like a serious illness. Plans would have to include hospice care. The bill also creates a narrow exception to self‑referral rules so patients in these plans can get durable medical equipment or covered Part D drugs from related providers within the plan.

• Who is affected: People on Medicare, Medicare Advantage plans, and providers in those networks.
• What changes: Auto‑enrollment into the lowest‑premium plan with an opt‑out; a three‑year lock‑in after enrolling; fixed per‑person payments; stricter rules on what diagnoses count; ending some quality‑based payment boosts; a cost “stop‑loss” option; hospice included in plans; a limited self‑referral exception for equipment and drugs under the plan.
• When: Most changes would start January 1, 2028.