# 119-hr-3467: To amend title XVIII to reform the Medicare Advantage program.

119-hr-3467, To amend title XVIII to reform the Medicare Advantage program., is a 119th Congress bill sponsored by Rep. Schweikert, David [R-AZ-1] (R-AZ); status introduced; PRIA reads it as touching household money (as of 2025-12-21).

- Canonical: https://policyrisk.com/legislation/119-hr-3467
- As of: 2025-12-21
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 119-hr-3467
- Congress: 119
- Title: To amend title XVIII to reform the Medicare Advantage program.
- Status: introduced
- Introduced: 2025-05-15
- Sponsor: Rep. Schweikert, David [R-AZ-1] (R-AZ)
- Cosponsors: 0
- Policy area: Health
- Touches household money: yes
- Last recorded action: 2025-12-21

## Summary

**Moves Medicare Advantage toward capitated payments.** This bill would require most Medicare Advantage plans to pay benefits on a capitated basis starting January 1, 2028 and would add automatic enrollment into the lowest-premium MA plan with an opt-out and a 3-year continuous enrollment rule. - Seniors and beneficiaries: Auto-enrollment would place people entitled to Part A and enrolled in Part B into the lowest-premium MA plan by default, and enrollees could opt out. The 3-year continuous enrollment period would generally prevent switching to another MA plan or traditional Medicare for that period except for hardship cases. - MA plans and insurers: Plans would face a capitated payment mandate with a lower blended benchmark beginning in 2028 and tighter risk adjustment rules that use only diagnoses from face-to-face or telehealth claims over a two-year look-back. The bill also removes future increases to the quality benchmark and creates a stop-loss payment system based on audited encounter data, with adjustments allowed for budget neutrality. - Providers and hospice care: The bill adds hospice-related exceptions for plans offered in 2028 or later and creates a Stark law exception for durable medical equipment and Part D drugs furnished under MA plans.

## Provisions PRIA read

- Lower payments to Medicare Advantage plans: cost, high. Beginning in 2028, risk scores would use only diagnoses from face-to-face or telehealth claim visits from the prior two years. Chart reviews and stand‑alone health risk assessments would not count. Also starting in 2028, the payment math would use 75% of one‑twelfth of the blended benchmark amount.…
- Hospice may be outside Medicare Advantage: cost, medium. For plan years beginning on or after January 1, 2028, Medicare Advantage plans would no longer be required to include hospice care. People who need hospice might have to get it outside their Medicare Advantage plan, which could change where they get care or what they pay.
- Automatic Medicare Advantage enrollment and 3-year lock: mixed, high. Starting with plan years on or after January 1, 2028, the government would automatically enroll people who have Part A and are in Part B into the lowest-premium Medicare Advantage plan available to them. If two or more plans have the same lowest premium, the Secretary would decide how to assign peo…
- Medicare Advantage capitation with stop-loss: mixed, high. For plan years starting January 1, 2028, Medicare Advantage plans would have to pay for benefits using capitation (a set payment per person). Specialized plans for people with special needs would be exempt, and plans from the prior year could keep limited reenrollment of their existing members. The…
- Stark exception for Medicare Advantage drugs and equipment: mixed, low. The bill would add a narrow exception to the physician self‑referral (Stark) rules for durable medical equipment and covered Part D drugs when given under a Medicare Advantage plan. This mainly affects provider contracting and legal compliance and could indirectly influence access.

## Related bills

- 119-hr-7705: Tribal Tax and Investment Reform Act of 2026
- 119-hr-4895: Afghan Adjustment Act
- 119-hr-2025: Northeastern Arizona Indian Water Rights Settlement Act of 2025
- 119-hr-4206: CONNECT for Health Act of 2025
- 119-hr-3466: SMART Act
- 119-hr-7971: Taxpayer Experience Improvement Act

## Sources
- [119-hr-3467 on Congress.gov](https://www.congress.gov/bill/119th-congress/house-bill/3467)

## Related
- [119-hr-7705: Tribal Tax and Investment Reform Act of 2026](https://policyrisk.com/legislation/119-hr-7705)
- [119-hr-4895: Afghan Adjustment Act](https://policyrisk.com/legislation/119-hr-4895)
- [119-hr-2025: Northeastern Arizona Indian Water Rights Settlement Act of 2025](https://policyrisk.com/legislation/119-hr-2025)
- [119-hr-4206: CONNECT for Health Act of 2025](https://policyrisk.com/legislation/119-hr-4206)
- [119-hr-3466: SMART Act](https://policyrisk.com/legislation/119-hr-3466)
- [119-hr-7971: Taxpayer Experience Improvement Act](https://policyrisk.com/legislation/119-hr-7971)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/119-hr-3467 (as of 2025-12-21).