Medicare Advantage MLR Transparency Act

More Medicare Advantage plan transparency

If enacted, this bill would require Medicare Advantage organizations, starting with plan years that begin on or after January 1, 2029, to submit to the Secretary and publish on each plan's public website plan-level medical loss ratio (MLR) data in a consumer-friendly format. The data would include each plan's total revenue; the dollar amount and percent of revenue spent on incurred claims; the dollar amount and percent spent on non-claims costs; the dollar difference between the MLR numerator and denominator; and that difference expressed as a percent of revenue. When calculating these amounts, regulatory references to an "MA contract" or "contract year" would be treated as an "MA plan" or "plan year." The Secretary could also require the same information to be published in the aggregate across all plans an organization offers. Separately, any Medicare Advantage plan information provided in electronic format on or after the first day of the first plan year that begins at least one year after enactment would, to the greatest extent practicable, have to use the same uniform electronic format used for group health plans under section 2715 of the Public Health Service Act.