Medicare Advantage Cost Transparency Act
Sponsored By: Representative DeGette, Diana [D-CO-1]
In Committee
Summary
More transparent Medicare Advantage pricing. This bill would require Medicare Advantage plans to report the allowed amount and the patient cost sharing for each item or service in encounter data for plan years starting January 1, 2027.
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- Medicare Advantage enrollees: Encounter records would include the allowed amount and any deductibles, copayments, or coinsurance tied to a service. The records would also note if the person received an at-home health risk assessment in the prior plan year.
- Medicare Advantage plans and CMS: Plans would have to submit expanded encounter data fields for each service, including cost-sharing details and distinct indicators for types of at-home assessments, for plan years beginning in 2027.
- Assessment entities: The bill defines an "assessment entity" that performs in-home health risk checks and creates a separate "specified assessment entity" label for entities with ownership or control ties to the Medicare Advantage organization.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
More price transparency for Medicare Advantage
If enacted, Medicare Advantage plans would have to include more price details in encounter data for plan years beginning on or after January 1, 2027. Plans would report the allowed amount and the amount of cost sharing for each item or service, including deductibles, copayments, and coinsurance. Plans would also add indicators showing whether an enrollee had, earlier in the same plan year, an at-home health risk assessment from an entity the plan or its owners control or from a different assessment entity. The Secretary would define what counts as an assessment entity and would tie the "specified" label to ownership or control rules in section 1124(a)(3).
Sponsors & CoSponsors
Sponsor
DeGette, Diana [D-CO-1]
CO • D
Cosponsors
Joyce (PA)
PA • R
Sponsored 6/23/2026
Roll Call Votes
No roll call votes available for this bill.
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