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Congress·In Committee·H.R. 6031

Congress Bill Sets Medicare Advantage Payment Floor Starting in 2026, Ties Half of Any Increase to Basic Benefits

Medicare Advantage Integrity Act of 2025

4 months ago·View on Congress.gov
⏸

Stalled

No legislative action in over 90 days.

Legislative Progress

House
Senate
President
Law

Key Points

  • Sets a minimum adjustment level for Medicare Advantage payment benchmarks starting in 2026, so some areas can’t fall below that floor.
  • This mainly affects places where traditional Medicare use is low, which can lead to lower Medicare Advantage benchmarks under current calculations.
  • Requires Medicare Advantage plans to use at least half of any extra payment from this change on basic covered services (the core medical benefits).
  • Could raise payments to Medicare Advantage plans in certain regions, which may influence what plans offer and what providers get paid in those areas.
HealthcareMedicare Medicaid

Impact Analysis

Personal Impact

How this policy affects specific groups of people

Mixed Impacts(4)
Medicare
Neutral
Retiree
Neutral
Chronic Illness
Neutral
Disability Benefits
Neutral

Milestones

2 milestones2 actions
Nov 12, 2025House

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.

Nov 12, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

During plan bidding/benefit design for the first plan year impacted by the higher benchmarks

Medicare Advantage plans must direct at least 50% of the payment increase from the new floor to basic covered benefits

If your plan is in an affected area, part of the extra money should show up as support for core medical coverage (for example, lower cost-sharing or more covered services), not just extra perks

Source Information

Document Type

Congressional Bill

Official Title

Medicare Advantage Integrity Act of 2025

Bill NumberHR 6031
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred 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.

Sponsor

Cosponsors

(2)
D: 1R: 1

Analysis generated by AI. Always verify with official sources.