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HR 5243

To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.

119th Congress Introduced by Jennifer McClellan

HR 5243 mandates Medicare Advantage plans to submit detailed data on supplemental benefits, enhancing transparency for enrollees and supporting healthcare research.

Introduced in House
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Bill Summary · HR 5243

Summary of HR 5243: Data Transparency for Supplemental Benefits under Medicare Advantage

Bill Number: HR 5243
Introduced: September 10, 2025
Status: Introduced in House
Classification: Bill

Purpose and Intent

HR 5243 aims to enhance data transparency regarding supplemental benefits provided under Medicare Advantage (MA) plans. The bill seeks to ensure that detailed information about these benefits is made available to the public and relevant stakeholders, thereby supporting better evaluations and research related to Medicare programs.

Key Provisions

The bill proposes the following amendments to Section 1857(e) of the Social Security Act:

  1. Data Submission Requirements:

    • Starting January 1, 2029, Medicare Advantage organizations will be required to submit detailed enrollee-level data on supplemental benefits. This data must include:
      • Eligibility for supplemental benefits
      • Types of benefit categories offered
      • Utilization data and payment information, including:
      • Total amount spent by the plan for each enrollee utilizing these benefits
      • Total out-of-pocket costs per utilization for each enrollee

  2. Annual Data Availability:

    • Beginning in 2030, the Secretary of Health and Human Services (HHS) will make the submitted data available annually on the first Monday of October. This data will be accessible for:
      • Evaluations and analyses supporting the Medicare program
      • Health care-related research

  3. Public Use Data Files:

    • By October 1 of each year starting in 2030, a public use data file containing the submitted information will be made available on the Centers for Medicare & Medicaid Services (CMS) website.

  4. Privacy Safeguards:

    • The Secretary will implement procedures to protect the privacy of individually identifiable enrollee information when making data available.

  5. Non-Interference Clause:

    • The amendments will not affect the collection of information as proposed in a prior notice published in the Federal Register on March 14, 2023.

Impact

Who Will Be Affected?

  • Medicare Advantage Organizations: These organizations will need to comply with new data submission requirements, which may involve changes to their data management practices.
  • Enrollees: Beneficiaries of Medicare Advantage plans will benefit from increased transparency regarding the supplemental benefits available to them.
  • Researchers and Analysts: The availability of detailed data will facilitate better research and analysis, potentially leading to improvements in Medicare programs and policies.

Procedural Aspects

  • The bill was referred to the Committee on Ways and Means and the Committee on Energy and Commerce for consideration. The timeline for further action will be determined by the Speaker of the House.

Conclusion

HR 5243 represents a significant step toward improving transparency in Medicare Advantage supplemental benefits. By mandating the collection and public availability of detailed data, the bill aims to enhance understanding and oversight of these benefits, ultimately benefiting enrollees and the healthcare system as a whole.

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

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