Protecting Options for Seniors Act of 2025
Sponsored By: Representative Tenney
Introduced
Summary
Fixes Medicare Advantage under-projections in local areas hit by big hospital wage-index jumps. It creates a targeted, data-driven growth adjustment to MA rate setting for local areas where the weighted hospital wage index rises more than 20%.
Show full summary
- Medicare Advantage plans in applicable local areas receive an extra growth adjustment added to the national per-capita MA growth percentage used to set rates. The adjustment is calculated from the area's wage-index change and a payment-weighting factor to produce a local growth percentage.
- The benchmark cap and base payment formulas are changed to take that local adjustment into account. For applicable areas the higher of specified base amounts will be used when computing the base payment amount.
- Hospitals in affected areas must have total Medicare Part A and Part B payments published separately at the hospital level. The adjustment must be benchmark-neutral so the enrollment-weighted average applicable amount does not change.
Applies beginning with the 2026 computations and publications for MA payment areas.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Higher Medicare Advantage payments in some areas
If enacted, Medicare Advantage payments would get a targeted boost in some local areas. Starting with 2026 rates, areas where the hospital wage index for 2025 or later jumps more than 20% would qualify. CMS would add extra growth equal to the area's percent wage-index change times a local payment share (for 2026, measured from 2024 to 2026). For those areas, CMS would use the higher of the standard base amount or the benchmark cap after this boost. CMS would also publish total Part A and Part B payments to each area hospital starting with 2026, and apply the boost so the average benchmark across all areas stays unchanged. If your MA plan is in an affected area, this could raise plan funding and may affect benefits or premiums.
Sponsors & CoSponsors
Sponsor
Tenney
NY • R
Cosponsors
Langworthy
NY • R
Sponsored 4/2/2025
Tonko
NY • D
Sponsored 4/2/2025
Lawler
NY • R
Sponsored 4/2/2025
Stefanik
NY • R
Sponsored 4/2/2025
Morelle
NY • D
Sponsored 4/7/2025
Kennedy (NY)
NY • D
Sponsored 4/7/2025
Riley (NY)
NY • D
Sponsored 4/8/2025
Mannion
NY • D
Sponsored 4/8/2025
Roll Call Votes
No roll call votes available for this bill.
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