Apples to Apples Comparison Act of 2026
- Bill Number
- S. 3848
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-02-11: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-03-02T19:34:55Z
AI-Generated Summary
Summary of S. 3848: Apples to Apples Comparison Act of 2026
Purpose
The legislation aims to increase transparency in Medicare spending by requiring the Secretary of Health and Human Services (HHS) to publish detailed, publicly accessible data on expenditures. It seeks to enable fair comparisons between Medicare Advantage (MA) plans and traditional fee-for-service (FFS) Medicare, while also mandating analyses and reports to inform policy decisions on program costs.
Key Provisions
- Publication of Expenditure Data (Section 2): Starting in 2027, the Centers for Medicare & Medicaid Services (CMS) must publish machine-readable files on its public website showing total and average Medicare expenditures. Data will cover:
- Beneficiaries in each U.S. county and Metropolitan Statistical Area (MSA, a geographic area defined by the U.S. Census Bureau for economic and social statistics).
- Monthly breakdowns for a 10-year historical period (ending the prior year) and up to 5 years of projected spending.
- Categories of individuals, including those eligible for hospital insurance (Part A), medical insurance (Part B), MA plans (Part C), prescription drug plans (Part D), federal health programs, group health plans, or Medicare supplemental policies. Examples include breakdowns for those enrolled only in Part A, only in Part B, in MA plans (including specialized plans for special needs), and employer group waiver plans.
- For the 2027 report, historical enrollment data from 2015 onward must also be included by county, MSA, and beneficiary categories.
- MEDPAC Analysis of MA vs. FFS Expenditures (Section 3): The Medicare Payment Advisory Commission (MEDPAC, an independent agency advising Congress on Medicare) must include in its annual reports (starting 2027) a retrospective comparison of average spending for MA enrollees versus comparable FFS beneficiaries (those eligible for MA but not enrolled). The analysis must:
- Use data from CMS actuaries and Medicare trust fund trustees.
- Account for differences in benefits (e.g., out-of-pocket caps, supplemental benefits, integrated drug coverage), demographics, and health risk scores (HCC scores, which adjust payments based on patient health status).
- Exclude favorable selection biases (where healthier people choose MA).
- Publicly release all data (protecting privacy), methodology (with 30 days for public comment), and responses to comments at least 60 days before submission.
- Trustees' Reports on Expenditures (Section 4): Starting in 2027, the Boards of Trustees for Medicare's Hospital Insurance Trust Fund (Part A) and Supplementary Medical Insurance Trust Fund (Parts B and D) must include in their annual reports aggregate and average spending data, broken down by:
- Beneficiaries in Part A only.
- Those in Part B only.
- Those in both Parts A and B but not in MA (with separate Part A and B spending).
- All public expenditure data must be disaggregated by these categories where possible.
Significant Changes to Existing Law
- Amends Section 1874 of the Social Security Act (governing administrative requirements) by expanding annual reports to include detailed, location-specific, machine-readable expenditure data starting in 2027, with new subsections on expenditures and trustees' reporting.
- Adds a new MEDPAC reporting requirement under Section 1805(b), mandating comparative analyses of MA and FFS spending that were not previously required at this level of detail or transparency.
- Introduces disaggregation of trust fund data by beneficiary enrollment types, enhancing granularity beyond current aggregate reporting.
Potential Impacts
- On Government Agencies: CMS, HHS, MEDPAC, and trust fund trustees will face increased administrative burdens to collect, analyze, and publish data, potentially requiring new systems for machine-readable formats and privacy protections. This could improve internal oversight of Medicare's financial health.
- On Citizens (Medicare Beneficiaries): Greater access to localized spending data may help individuals understand costs in their area, compare plan options, and make informed enrollment decisions, though complex categories might limit direct usability without simplification.
- On International Relations: No direct impact, as this is a domestic health program.
- Broader effects include fostering evidence-based policymaking on Medicare sustainability, potentially influencing payment rates, benefit designs, and program reforms.
Main Stakeholders Affected
- Medicare Beneficiaries: Gain transparency on spending patterns, which could affect plan choices and awareness of regional cost variations.
- Healthcare Providers and Insurers: MA plan operators (e.g., private insurers) may face scrutiny over spending comparisons; providers in FFS Medicare could see shifts if analyses reveal disparities.
- Government Entities: HHS, CMS (data publishers), MEDPAC (analysts), and Medicare trust fund trustees (reporters) bear implementation responsibilities.
- Policymakers and Researchers: Congress, analysts, and advocacy groups benefit from replicable data for studying overpayments, risk adjustments, and program efficiency.
- Taxpayers: Indirectly affected through better-informed decisions on Medicare's $800+ billion annual budget.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens data transparency requirements under the Social Security Act without altering core Medicare benefits or eligibility. Ensures privacy protections for personal health data, aligning with laws like HIPAA (Health Insurance Portability and Accountability Act). Machine-readable formats promote compliance with open data initiatives like the DATA Act (Digital Accountability and Transparency Act).
- Constitutional: No apparent issues; falls under Congress's spending power (Article I, Section 8) to regulate federal programs like Medicare.
- Political: Could intensify debates on MA overpayments (where private plans receive higher funding than FFS costs for similar beneficiaries), potentially leading to payment reforms. Promotes bipartisan goals of fiscal accountability but may draw opposition from MA industry stakeholders concerned about negative analyses. The public comment process on methodologies enhances democratic input without binding legal effect.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2026-02-11: Read twice and referred to the Committee on Finance.
- 2026-02-11: Introduced in Senate
Bill Versions
- Apples to Apples Comparison Act of 2026 — issued 2026-02-11 — PDF (13 pages)