To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.
- Bill Number
- H.R. 5243
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-25: Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote.
- Last Updated
- 2026-06-27T08:06:48Z
AI-Generated Summary
Purpose of the legislation This bill amends the Social Security Act to require Medicare Advantage (MA) plans, which are private insurance options under Medicare, to report more detailed information on supplemental benefits. The goal is to improve transparency and support research on how these extra benefits are used.
Key provisions outlined
- Beginning with plan years starting January 1, 2029, MA organizations must submit enrollee-level data on supplemental benefits to the Secretary of Health and Human Services.
- Data must include eligibility for benefits, types of benefits offered, utilization rates, total spending per enrollee, out-of-pocket costs, and details by item or service and provider identifier.
- Starting in 2030, the Secretary must release this data for program evaluations, health care research, and other analyses.
- A public use data file must be posted on the Centers for Medicare & Medicaid Services (CMS) website each October.
- Procedures must protect the privacy of individual enrollee information.
- A rule of construction states that the new requirements do not change other proposed data collections referenced in a 2023 Federal Register notice.
Significant changes to existing law introduced The bill adds a new paragraph (6) to Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)). This creates mandatory reporting of detailed, enrollee-specific data on supplemental benefits, which was not previously required at this level.
Potential impacts on government agencies, citizens, or international relations
- Government agencies: CMS will gain access to more granular data for oversight and analysis, potentially improving program management.
- Citizens: Researchers and the public may benefit from greater insight into benefit usage, which could inform future policy decisions.
- International relations: No effects are specified in the bill.
Main stakeholders affected by this legislation
- Medicare Advantage organizations and the plans they offer.
- Individuals enrolled in Medicare Advantage plans.
- The Department of Health and Human Services and CMS.
- Health care researchers and analysts seeking data for studies.
Notable legal, constitutional, or political implications The bill includes explicit privacy safeguards for enrollee data. It has no direct constitutional provisions and maintains neutrality regarding other ongoing data collection efforts.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. McClellan, Jennifer L. [D-VA-4]
Recent Actions
- 2026-06-25: Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote.
- 2026-06-25: Subcommittee Consideration and Mark-up Session Held
- 2025-09-10: Referred to the Subcommittee on Health.
- 2025-09-10: 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.
- 2025-09-10: 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.
- 2025-09-10: Introduced in House
- 2025-09-10: Introduced in House
Bill Versions
- To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. — issued 2025-09-10 — PDF (3 pages)