This bill would require Medicare Advantage plans to report enrollee-level data on supplemental benefits, starting with plan years on or after January 1, 2029. The data would cover benefits by item or service, eligibility, benefit categories offered, utilization, payments, total plan spending per enrollee who used the benefit, and out-of-pocket cost per use. Beginning in 2030, the Centers for Medicare & Medicaid Services would have to share the data annually for research and program analysis and also post a public use data file online.
What This Bill Does
- Requires MA plans to report enrollee-level supplemental benefits data starting with plan years on or after January 1, 2029.
- Covers benefit eligibility, benefit categories, utilization, payments, and the national provider identifier.
- Includes total amount spent by the plan for each enrollee who used the benefit and out-of-pocket cost per utilization.
- CMS must share the data for research and program analysis on the first Monday in October beginning in 2030.
- CMS must post a public use data file online by October 1 each year beginning in 2030.
Who This Bill Affects
If you are enrolled in a Medicare Advantage plan, this bill could indirectly affect you by making your plan’s supplemental benefits more visible to researchers, policymakers, and CMS. It would not change your eligibility or benefits right away, but it could lead to future plan oversight, comparisons, or policy changes based on detailed spending and utilization data. For people not in Medicare Advantage, the bill would mainly matter only through broader improvements in how the program is studied and regulated.
See how this bill affects you — sign in for a personalized analysisWho Supports & Opposes This
- Medicare Advantage beneficiaries and patient advocates They may support the bill because better reporting can make it easier to compare how plans actually use supplemental benefits and whether those benefits are reaching enrollees as advertised. More transparency could also help identify gaps between plan promises and real-world access.
- Health policy researchers and watchdog groups They are likely to favor standardized enrollee-level data because it would support evaluation of spending, utilization, and outcomes across MA plans. The public use file could make independent analysis much easier and improve oversight of a large federal program.
- Federal policymakers focused on program integrity They can argue that detailed reporting helps CMS monitor whether supplemental benefits are being used efficiently and whether public funds are supporting the intended services. The data could also help detect patterns that deserve closer review.
- Medicare Advantage insurers and plan administrators They may argue that enrollee-level reporting adds administrative complexity and compliance costs, especially because the bill requires detailed information by item or service, category, and payment amounts. Plans may also worry about how the data could be interpreted without full context.
- Privacy advocates They could be concerned that even with safeguards, enrollee-level data create privacy risks when combined with other information. A public use file can be valuable for research, but it also raises questions about re-identification and data protection.
- Organizations that handle sensitive health data They may caution that implementing and maintaining these reporting systems will require careful technical controls and ongoing oversight. The October 2030 and annual deadlines could be challenging if CMS and plans need to build new data pipelines.
Key Implications
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““Beginning with plan years beginning on or after January 1, 2029””
The reporting requirement would not begin immediately. MA organizations would have several years to build systems before they have to submit the new enrollee-level supplemental benefits data.
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““enrollee-level data on supplemental benefits””
This is a very detailed reporting standard, not just a high-level summary. It would let CMS and researchers examine how individual enrollees use supplemental benefits and what those benefits cost.
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““including the total amount spent by the plan for each enrollee””
This provision would expose the plan-side cost of supplemental benefits at the enrollee level. That can help evaluate value and utilization, but it also increases the sensitivity of the data being handled.
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““make a public use data file… available on the internet website of the Centers for Medicare & Medicaid Services””
The bill does not limit the data to internal government use. It would create a public-facing resource that outside researchers, journalists, and advocates could use to study MA supplemental benefits.
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““procedures to safeguard the privacy of any individually identifiable enrollee information””
Congress is explicitly requiring privacy protections because the reporting is granular. The practical challenge will be making the data useful while preventing disclosure of personal health information.
Official Source & Bill Facts
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- Bill
- HR 5243
- Congress
- 119th Congress
- Official title
- To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.
- Policy area
- Healthcare
- Latest action
- Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote. (June 25, 2026)
- Last updated
- June 27, 2026
Latest Status
June 25, 2026
Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote.
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Ask AI about this billData sourced from api.congress.gov.