HR 4093
Apples to Apples Comparison Act of 2025
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Bill overview
The Apples to Apples Comparison Act of 2025 aims to increase transparency in Medicare spending by requiring the Department of Health and Human Services to publish detailed expenditure data. Specifically, the bill mandates the Centers for Medicare & Medicaid Services to release monthly data broken down by various categories of beneficiaries, including those enrolled in traditional Medicare, Medicare Advantage plans, and those with prescription drug coverage. It also directs the Medicare Payment Advisory Commission (MedPAC) to analyze and report on the cost differences between Medicare Advantage and traditional fee-for-service plans. Finally, the Boards of Trustees will include expenditure information for different beneficiary categories in their annual reports.
Key provisions
- Requires the Centers for Medicare & Medicaid Services to publish monthly Medicare expenditure data broken down by beneficiary categories.
- Mandates the inclusion of enrollment information in the published data, categorized by county and Metropolitan Statistical Area.
- Directs MedPAC to analyze and report on cost differences between Medicare Advantage and traditional fee-for-service plans.
- Requires the Boards of Trustees to include expenditure information for different beneficiary categories in their annual reports.
- Establishes a timeframe for the initial publication of data, beginning with 2025.
- Includes a provision for data to be published in machine-readable files.
- Requires the publication of historical and projected expenditure data.
- Specifies the categories of individuals for which expenditure data must be reported.
Who is affected
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119th CONGRESS — 1st Session
H. R. 4093
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend title XVIII of the Social Security Act to require the Secretary of Health and Human Services to publish information on expenditures under the Medicare program, and for other purposes.
This Act may be cited as the Apples to Apples Comparison Act of 2025
.
Section 1874 of the Social Security Act (42 U.S.C. 1395kk) is amended—
in subsection (g)—
in paragraph (1)—
in the matter preceding subparagraph (A), by inserting (and, beginning with 2025, publish on the public website of the Centers for Medicare & Medicaid Services in machine-readable files information on)
after a report on
;
in subparagraph (A), by inserting (and, beginning with 2025, by county and Metropolitan Statistical Area)
after State
; and
in subparagraph (B)—
in clause (ii), by striking and
at the end;
in clause (iii), by striking the period and inserting ; and
; and
by adding at the end the following new clause:
by adding at the end the following new paragraph:
by adding at the end the following new subsection:
Individuals entitled to benefits under part A and not enrolled under part B.
Individuals who are—
not entitled to benefits under part A;
enrolled under part B; and
not enrolled under a Medicare Advantage plan under part C.
Individuals who are—
entitled to benefits under part A and enrolled under part B; and
not enrolled under a Medicare Advantage plan under part C.
Individuals described in subparagraph (A) who are enrolled in a prescription drug plan under part D.
Individuals described in subparagraph (B) who are enrolled in a prescription drug plan under part D.
Individuals described in subparagraph (C) who are enrolled in a prescription drug plan under part D.
Individuals described in subparagraph (A) who are not enrolled in a prescription drug plan under part D.
Individuals described in subparagraph (B) who are not enrolled in a prescription drug plan under part D.
Individuals described in subparagraph (C) who are not enrolled in a prescription drug plan under part D.
Individuals described in subparagraph (A) who are enrolled in a Federal health care program (as defined in section 1128B) or a health plan under chapter 89 of title 5, United States Code.
Individuals described in subparagraph (B) who are enrolled in such a program or plan.
Individuals described in subparagraph (C) who are enrolled in such a program or plan.
Individuals described in subparagraph (A) who are not enrolled in such a program or plan.
Individuals described in subparagraph (B) who are not enrolled in such a program or plan.
Individuals described in subparagraph (C) who are not enrolled in such a program or plan.
Individuals described in subparagraph (A) who are enrolled in a group health plan (as defined in section 2791 of the Public Health Service Act) or a medicare supplemental policy under section 1882.
Individuals described in subparagraph (B) who are enrolled in such a plan or policy.
Individuals described in subparagraph (C) who are enrolled in such a plan or policy.
Individuals described in subparagraph (A) who are not enrolled in such a plan or policy.
Individuals described in subparagraph (B) who are not enrolled in such a plan or policy.
Individuals described in subparagraph (C) who are not enrolled in such a plan or policy.
Individuals enrolled in an MA plan other than a plan described in subparagraph (V).
Individuals enrolled in an MA plan.
Individuals described in subparagraph (X) who are not enrolled in such a program or plan.
Individuals described in subparagraph (X) who are enrolled in a prescription drug plan under part D.
Individuals described in subparagraph (X) who are not enrolled in such a plan.
Individuals described in subparagraph (X) who are enrolled in an MA–PD plan.
Individuals described in subparagraph (X) who are not enrolled in such a plan.
Individuals described in subparagraph (CC) or (EE) who are not enrolled in such a program or plan.
Individuals enrolled in an employer group waiver plan.
For purposes of this subsection:
specified historical periodmeans, with respect to a year, the 10-year period ending on the last day of such year.
The term specified projected period
means, with respect to a year, the period beginning on the first day of the subsequent year of a duration specified by the Secretary (but in no case to exceed a duration of 5 years).
Section 1805(b) of the Social Security Act (42 U.S.C. 1395b–6(b)) is amended by adding at the end the following new paragraph:
In preparing each analysis described in subparagraph (A), the Commission shall—
use data provided by the Chief Actuary of the Centers for Medicare & Medicaid Services and the Boards of Trustees of the Federal Hospital Insurance Trust Fund established under section 1817 and the Federal Supplementary Medical Insurance Trust fund established under section 1841 and such other data as the Commission determines appropriate;
take into account—
differences in value provided under Medicare Advantage plans compared to the value provided under parts A and B, such as the existence of out-of-pocket expenditure caps, supplemental benefits available under such plans, and the integration of benefits for covered part D drugs under certain such plans; and
demographic differences of individuals enrolled in Medicare Advantage plans compared to individuals entitled to benefits under part A and enrolled under part B who are not enrolled in such a plan; and
take into account differences in HCC risk scores but not take into account any favorable selection differences with respect to enrollment in such plans.
With respect to each analysis described in subparagraph (A), the Commission shall—
make public all data used in preparing such analysis in a manner that—
allows replication of such analysis; and
protects the confidentiality of personal information of individuals entitled to benefits under part A and enrolled under part B;
not later than 60 days prior to the submission of such analysis, make public the methodology used to conduct such analysis and allow at least 30 days for public comment on such methodology; and
Section 1874 of the Social Security Act (42 U.S.C. 1395kk), as amended by section 2, is further amended by adding at the end the following new subsection:
Individuals entitled to benefits under part A and not enrolled under part B.
Individuals enrolled under part B and not entitled to benefits under part A.
Individuals entitled to benefits under part A, enrolled under part B, and not enrolled in a Medicare Advantage plan under part C.
The Boards of Trustees described in paragraph (1) shall, as part of all expenditure data (including data tables) made public by such Boards, disaggregate such data, to the extent practicable, based on the categories of individuals described in paragraph (1).