Medicare Advantage Cost Transparency Act

Diana DeGette

Democrat · CO · Representative

Source: Congress.gov · FEC

• John Joyce (R-PA-13)Original· 2026-06-23

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

2026-06-23

Source: Congress.gov

Medicare Advantage insurance plans would be required to submit more detailed information about patient visits and medical services to Medicare, giving the government better data about what care is actually being provided. This would help Medicare track spending patterns, identify potential fraud, and understand how well these private insurance plans are serving seniors. The change affects Medicare Advantage insurers and the seniors enrolled in their plans.

AI-assisted summary generated from the official bill metadata (title, subjects, actions) sourced from Congress.gov. Cached and reviewed. Always verify against the official text linked below.

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 9392 Introduced in House (IH)] <DOC> 119th CONGRESS 2d Session H. R. 9392 To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES June 23, 2026 Ms. DeGette (for herself and Mr. Joyce of Pennsylvania) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage encounter data. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Medicare Advantage Cost Transparency Act''. SEC. 2. REQUIRING THE INCLUSION OF CERTAIN INFORMATION IN ENCOUNTER DATA. Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the following new subsection: ``(j) Inclusion of Certain Information in Encounter Data.-- ``(1) In general.--In the case of any encounter data submitted by a Medicare Advantage plan with respect to an item or service furnished to an individual under such plan during a plan year beginning on or after January 1, 2027, the Secretary shall require that such data include-- ``(A) the allowed amount for such item or service; ``(B) the amount of cost sharing (including deductibles, copayments, and coinsurance) imposed for such item or service; ``(C) in the case such individual was furnished, during such plan year before such item or service was so furnished, an at-home health risk assessment from a specified assessment entity, an indicator that such individual was so furnished such an assessment by such an entity; and ``(D) in the case such individual was furnished, during such plan year before such item or service was so furnished, an at-home health risk assessment from an assessment entity not described in subparagraph (C), an indicator (distinct from the indicator described in such subparagraph) that such individual was so furnished such an assessment by such an entity. ``(2) Definitions.--In this subsection: ``(A) Assessment entity.--The term `assessment entity' means an entity with a focus on furnishing in- home health risk assessments, as specified by the Secretary. ``(B) Specified assessment entity.--The term `specified assessment entity' means, with respect to an MA organization and a plan year, an assessment entity with respect to which such organization (or any person with an ownership or control interest (as defined in section 1124(a)(3)) in such organization) is a person with an ownership or control interest (as so defined).''. <all>

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