Medicare Advantage MLR Transparency

Summary#

This bill amends the Social Security Act to require Medicare Advantage (MA) organizations to share more plan-level financial information. Beginning with plan years that start on or after January 1, 2029, each MA plan must submit to the Secretary and publish on the organization’s public website, in a consumer-friendly format set by the Secretary, the following: total plan revenue; the amount and percentage of revenue spent on incurred claims; the amount and percentage of revenue spent on non-claims costs; the difference between the MLR numerator and MLR denominator; and that difference expressed as a percentage of revenue. The Secretary may also require the same information to be reported and published in the aggregate across all plans offered by an organization. The bill directs that references in existing MLR rules to “contract” or “contract year” be treated as “plan” or “plan year” for these reporting purposes. Separately, the bill requires that electronic benefit information provided on or after the first plan year that begins at least one year after enactment be presented, to the greatest extent practicable, in the same uniform format used for group health plans and health insurance issuers under section 2715 of the Public Health Service Act.

What it means for you#

• MA organizations must publish plan-level financial figures (revenue, claims share, non-claims costs, and the MLR numerator/denominator difference) on their public websites.
• The Secretary will specify a consumer-friendly format for those disclosures.
• Electronic benefit information provided after the specified effective date must, as much as possible, use the same uniform format that other group health plans use under section 2715.
• No publicly available information on how these changes will affect premiums, benefits, or enrollment.

Expenses#

• The bill text does not include cost estimates or budget information.
• The bill requires submission and publication of additional data, which may create administrative work for MA organizations and for the agency that collects or posts the data, but the bill does not state any specific costs or who would pay them.
• No publicly available information on estimated federal or plan costs.

Proponents' View#

No publicly available information in the bill text or provided metadata that states proponents’ reasons or arguments.

Opponents' View#

No publicly available information in the bill text or provided metadata that states opponents’ reasons or arguments.