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HR 6031

Medicare Advantage Integrity Act of 2025

119th Congress Introduced by María Salazar and 1 co-sponsor

The Medicare Advantage Integrity Act of 2025 sets a minimum funding rate for plans in underserved areas, improving care access for beneficiaries and supporting healthcare providers.

Introduced in House
8
WeVote Research Nonpartisan
Bill Summary · HR 6031

Summary of HR 6031 - Medicare Advantage Integrity Act of 2025

Purpose and Intent

The Medicare Advantage Integrity Act of 2025 (HR 6031) aims to amend the Social Security Act to establish a minimum benchmark rate for Medicare Advantage plans in regions where there is low penetration of Medicare fee-for-service (FFS) programs. The intent is to address disparities in Medicare Advantage funding and ensure that beneficiaries in underserved areas receive adequate resources and care.

Key Provisions

The bill introduces several significant changes to the Medicare Advantage program:

  1. Establishment of a Benchmark Rate Floor:

    • The bill amends Section 1853(n) of the Social Security Act to ensure that the average geographic adjustment for Medicare Advantage plans will not fall below 0.70 for any area starting in 2026. This adjustment is crucial for calculating the adjusted average per capita cost used to determine base payment amounts.

  2. Allocation of Increased Payments:

    • An additional provision under Section 1854(a)(6) mandates that at least 50% of any increase in the blended benchmark amount, resulting from the new geographic adjustment floor, must be directed towards payment for basic benefits as defined in Section 1852(a)(1)(B). This ensures that increased funding is effectively utilized to enhance patient care.

Affected Parties

The bill primarily impacts:
- Medicare Advantage beneficiaries in regions with low Medicare FFS penetration, who may benefit from improved access to care and services.
- Healthcare providers in these areas, who may receive increased payments for delivering basic benefits to Medicare Advantage enrollees.
- Medicare Advantage plans, which will need to adjust their operations and financial planning in response to the new benchmark rates.

Procedural Aspects

  • Introduced: November 12, 2025
  • Current Status: The bill has been referred to the Committee on Ways and Means and the Committee on Energy and Commerce for further consideration. The timeline for subsequent actions will be determined by the Speaker of the House.

Conclusion

The Medicare Advantage Integrity Act of 2025 seeks to rectify funding disparities in Medicare Advantage plans, particularly in underserved regions. By establishing a benchmark rate floor and ensuring that increased payments are directed towards patient care, the bill aims to enhance the quality and accessibility of healthcare for Medicare beneficiaries.

Compiled from official sources — confirm details with the bill’s official record.

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