Congress guarantees higher Medicare Advantage payments in weak-competition regions
H.R. 6031 — Medicare Advantage Integrity Act of 2025 · Filed by Pablo José Hernández Rivera (D-PR) · 2 cosponsors · Introduced Nov 12, 2025 · Referred to committee
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What it does
This bill sets a floor on Medicare Advantage payment rates in regions where traditional Medicare is less common. It requires that the geographic adjustment factor used to calculate benchmark payments cannot fall below 0.70, and mandates that at least 50% of any resulting payment increase must go toward basic benefits (not administrative costs or profit margins).
Why we flagged it
The bill's operative mechanism is a regulatory floor on benchmark payment adjustments in specific geographic regions, coupled with a care-spending mandate. It is fundamentally a payment-rate adjustment for a specific insurance product line.
What the text implies
- The 0.70 floor may create payment disparities between low-penetration and high-penetration regions, potentially subsidizing MA plans in areas where traditional Medicare is weak.
- The 50% care-spending mandate applies only to the incremental increase, not the total benchmark, leaving room for plans to allocate the baseline payment to administrative costs or profit.
The full analysis lists 4 implications of this text.
Who stands to gain
Medicare Advantage insurers (UnitedHealth, Humana, CVS Aetna, Anthem); MA plan networks and provider groups in low-penetration regions