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Congress·In Committee·4 months ago

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

Also known as: Medicare Advantage Integrity Act of 2025

Legislative Progress

✓ Filed
Review
House
Senate
President

Impacts

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

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

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

Related News

5 articles
Metro Puerto Rico·4 months ago

Comisionado Residente presenta proyecto para mejorar el Medicare Advantage en Puerto Rico

Cubre la presentación del H.R. 6031 y sus efectos: establecer un piso para benchmarks en áreas de baja penetración FFS y requerir que 50% del aumento se dirija a beneficios básicos.

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El Diario NY·4 months ago

Pablo José Hernández presenta junto a María Elvira Salazar proyecto para incrementar pagos Medicare Advantage en Puerto Rico

Explica el H.R. 6031 (introducido 2025-11-12): piso mínimo para benchmarks de MA en áreas con alta penetración de MA/baja FFS y reinversión mínima del 50% del aumento en beneficios esenciales.

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NewsPR·4 months ago

Comisionado Resdiente presenta proyecto para mejorar Medicare Advantage

Nota sobre la radicación del Medicare Advantage Integrity Act (H.R. 6031) y el objetivo de asegurar pagos más equitativos; incluye el requisito de destinar una parte del aumento a beneficios básicos.

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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. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.