Apples to Apples Comparison Act of 2025
- Bill Number
- H.R. 4093
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-24: 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.
- Last Updated
- 2026-06-19T08:06:35Z
AI-Generated Summary
Purpose of the Legislation
The "Apples to Apples Comparison Act of 2025" aims to increase transparency in Medicare spending by requiring detailed public reporting and analysis of expenditures. It focuses on comparing costs between traditional Medicare (fee-for-service) and Medicare Advantage plans, helping to make spending data more accessible and comparable for better oversight and decision-making.
Key Provisions
- Enhanced Medicare Expenditure Reporting (Section 2): The Secretary of Health and Human Services (HHS) must publish detailed Medicare spending data on the Centers for Medicare & Medicaid Services (CMS) public website starting in 2025. This includes total and average expenditures for items and services, broken down by:
- Geographic areas (county and Metropolitan Statistical Area, or MSA—a region defined by the U.S. Census Bureau for economic and social statistics).
- Time periods: A 10-year historical look-back and up to 5 years of projections.
- Beneficiary categories, such as those eligible for hospital insurance (Part A) only, medical insurance (Part B) only, both Parts A and B without Medicare Advantage (Part C), enrollment in prescription drug coverage (Part D), specialized Medicare Advantage plans for people with special needs, employer group waiver plans, and overlaps with other health programs (e.g., federal employee plans or group health plans).
- Data must be in machine-readable files (formats like CSV that computers can easily process) for easy analysis.
- For the 2025 report, historical enrollment data from 2015 onward must also be included by county, MSA, and beneficiary categories.
- MedPAC Analysis of Medicare Advantage vs. Fee-for-Service (Section 3): The Medicare Payment Advisory Commission (MedPAC—an independent group that advises Congress on Medicare issues) must include in its annual reports starting in 2026 a comparison of average spending for people in Medicare Advantage plans versus those in traditional fee-for-service Medicare (where providers are paid per service). The analysis must:
- Use data from CMS actuaries and trust fund trustees.
- Account for differences in benefits (e.g., out-of-pocket caps, extra benefits in Medicare Advantage), demographics, and health risk scores (HCC scores, which adjust payments based on patient health complexity), but not favorable selection (healthier people choosing Medicare Advantage).
- Be transparent: Publicly release data and methods for replication (while protecting personal privacy), allow 30 days for public comments on methods, and respond to comments.
- Trustees' Reports on Expenditures (Section 4): Starting in 2026, the Boards of Trustees for Medicare's Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) Trust Funds must include in their annual reports aggregate and average spending data by beneficiary categories (e.g., Part A only, Part B only, both without Medicare Advantage). They must also disaggregate (break down) all public expenditure data by these categories where possible.
Significant Changes to Existing Law
- Amends Section 1874 of the Social Security Act to expand annual Medicare reports into detailed, public, machine-readable publications by geography and beneficiary type, adding historical and projected data—previously, reports were less granular and not required in digital formats.
- Adds a new MedPAC mandate under Section 1805 for retrospective spending comparisons between Medicare Advantage and fee-for-service, with strict transparency rules not previously required.
- Modifies trustees' reports under Sections 1817 and 1841 to include categorized spending breakdowns, enhancing disaggregation of existing public data tables.
Potential Impacts
- Government Agencies: CMS and HHS will face increased administrative workload to compile, publish, and maintain detailed data, potentially requiring new systems for machine-readable formats. MedPAC and trustees will need to integrate new analyses, which could inform future Medicare payment policies.
- Citizens: Medicare beneficiaries (over 65 million elderly and disabled Americans) gain better access to spending information, aiding informed choices between traditional Medicare and Medicare Advantage plans. Researchers and the public can more easily analyze trends, potentially leading to greater awareness of cost variations by location and plan type.
- International Relations: No direct impacts, as this is a domestic health program.
Main Stakeholders Affected
- Medicare Beneficiaries: Primary users of the data for understanding costs and benefits in their coverage options.
- Healthcare Providers and Insurers: Medicare Advantage plan operators (private insurers) may face scrutiny from spending comparisons; fee-for-service providers could see shifts in enrollment based on revealed cost differences.
- Policymakers and Congress: Benefit from MedPAC analyses to guide reforms, budgeting, and oversight of Medicare's $800+ billion annual spending.
- Government Entities: CMS, HHS, MedPAC, and trust fund trustees bear implementation responsibilities.
- Researchers and Advocacy Groups: Gain tools for independent studies on equity, efficiency, and access in Medicare.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens accountability under the Social Security Act by mandating data transparency without creating new enforcement mechanisms or penalties; ensures privacy protections in data release to comply with health information laws like HIPAA (Health Insurance Portability and Accountability Act).
- Constitutional: No apparent challenges, as it involves congressional authority over federal spending programs and does not infringe on individual rights.
- Political: Could fuel debates on Medicare Advantage overpayments (often criticized as higher than fee-for-service) versus its benefits, influencing bipartisan efforts to control costs amid rising Medicare insolvency projections (trust funds projected to deplete by the 2030s). Promotes evidence-based policymaking, potentially reducing partisan disputes through public data access.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (24)
Rep. Hern, Kevin [R-OK-1], Rep. Yakym, Rudy [R-IN-2], Rep. Miller, Carol D. [R-WV-1], Rep. Van Duyne, Beth [R-TX-24], Rep. Tenney, Claudia [R-NY-24], Rep. Steube, W. Gregory [R-FL-17], Rep. Fischbach, Michelle [R-MN-7], Rep. Carey, Mike [R-OH-15], Rep. Shreve, Jefferson [R-IN-6], Rep. Cammack, Kat [R-FL-3], Rep. Langworthy, Nicholas A. [R-NY-23], Rep. Moore, Blake D. [R-UT-1], Rep. Fedorchak, Julie [R-ND-At Large], Rep. Kelly, Mike [R-PA-16], Rep. Lee, Laurel M. [R-FL-15], Rep. Miller, Max L. [R-OH-7], Rep. Malliotakis, Nicole [R-NY-11], Rep. Feenstra, Randy [R-IA-4], Rep. Pfluger, August [R-TX-11], Rep. Smucker, Lloyd [R-PA-11], Rep. LaHood, Darin [R-IL-16], Rep. Smith, Adrian [R-NE-3], Rep. Moran, Nathaniel [R-TX-1], Rep. Kustoff, David [R-TN-8]
Recent Actions
- 2025-06-24: 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.
- 2025-06-24: 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.
- 2025-06-24: Introduced in House
- 2025-06-24: Introduced in House
Bill Versions
- Apples to Apples Comparison Act of 2025 — issued 2025-06-24 — PDF (13 pages)