Medicare Advantage Cost Transparency Act
Jun 23, 2026
Introduced: Jun 23, 2026
Jun 23, 2026
Introduced: Jun 23, 2026
Summary
Makes Medicare Advantage plans report the allowed cost, patient's share of the cost, and if they had a home health check-up for every service.
What problem does this solve?
It is difficult to see the true costs of services in Medicare Advantage plans, making it hard to track spending. This bill requires plans to report these costs clearly, creating more transparency for the government and patients.
What does this bill do?
Reference
Text:
Section:
Sec. 2(j)(1)(A)
Header:
Requiring the inclusion of certain information in encounter data
Requires reporting of allowed service costs
Mandates that for every service provided, Medicare Advantage plans must report the total 'allowed amount,' which is the full cost the plan agrees to pay.
Reference
Text:
Section:
Sec. 2(j)(1)(B)
Header:
Requiring the inclusion of certain information in encounter data
Requires reporting of patient cost-sharing
Requires plans to report the specific amount a patient paid out-of-pocket for each service, including deductibles, copayments, and coinsurance.
Reference
Text:
Section:
Sec. 2(j)(1)(C)
Header:
Requiring the inclusion of certain information in encounter data
Tracks at-home health risk assessments
Adds a special indicator to the data if a patient received an at-home health risk assessment during the plan year.
Reference
Text:
Section:
Sec. 2(j)(1)(D)
Header:
Requiring the inclusion of certain information in encounter data
Identifies health assessment company ownership
Requires a separate indicator to show whether the company performing an at-home health assessment is owned by or related to the Medicare Advantage insurance company.
Who does this affect?
- Seniors on Medicare Advantage
- Medicare Advantage insurance companies
- Healthcare providers
What is the real world impact?
•
Increases transparency in Medicare Advantage spending
Requires private insurance plans under Medicare to report detailed cost data for every service. This helps the government and public understand how taxpayer money is being spent on senior healthcare.
•
Allows for better oversight of at-home health assessments
Highlights when at-home health check-ups are used. This helps regulators see if these assessments are improving care or just being used by plans to increase their government payments by documenting more health conditions.
When does this start?
The new reporting requirements would apply to all Medicare Advantage plan years starting on or after January 1, 2027.