Medicare gains a window into what Advantage plans really charge you
H.R. 9392 — Medicare Advantage Cost Transparency Act · Filed by Diana DeGette (D-CO) · 1 cosponsor · Introduced Jun 23, 2026 · Markup held
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What it does
This bill requires Medicare Advantage plans to include four new data points in their encounter records starting January 2027: the allowed amount for each service, the patient's cost-sharing obligation, and indicators showing whether the patient received an in-home health risk assessment—separately flagging assessments from entities the plan owns versus independent entities. The goal is to give Medicare and researchers better visibility into what MA plans actually charge patients and which plans are steering patients toward affiliated assessment providers.
Why we flagged it
The bill's operative mechanism is a data-disclosure mandate designed to expose MA plan pricing and potential steering of patients toward affiliated assessment entities. It is a transparency and accountability measure, not a payment reform or benefit expansion.
What the text implies
- The bill requires plans to separately flag assessments from 'specified assessment entities' (those with ownership ties to the plan) versus independent entities. This creates a permanent audit trail of potential self-dealing, which may incentivize plans to reduce or disclose such relationships rather than hide them.
- Encounter data is used by CMS to set future MA payment rates and by researchers to study plan behavior. Mandatory disclosure of allowed amounts and cost-sharing may reveal wide variation in what different plans charge for identical services, potentially triggering pressure for rate standardization or competitive disclosure.
The full analysis lists 3 implications of this text.
Who it affects
Ordinary Medicare beneficiaries gain transparency into what they are actually paying and whether their MA plan is steering them toward affiliated providers—information needed to make informed plan choices and to detect self-dealing. Regulators and researchers gain data to monitor MA plan pricing and conflicts of interest, supporting market accountability.