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HR 9395

Transparency in Medicare Advantage Steering Act

119th Congress Introduced by Alexandria Ocasio-Cortez

The bill would require Medicare Advantage plans to report, and later publicly disclose, details about enrollment intermediaries (agents/brokers), including compensation.

Introduced in House
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WeVote Research Nonpartisan
Bill Summary · HR 9395

Overview

HR 9395, the Transparency in Medicare Advantage Steering Act, introduced in the 119th Congress, would require Medicare Advantage (MA) organizations to report information about agents, brokers, and other third parties involved in enrolling individuals in MA plans. The bill aims to increase transparency around enrollment activities and the compensation paid to intermediaries, and to make enrollment-related data publicly accessible starting in 2030.

Purpose and intent

  • Improve transparency regarding how MA enrollments are facilitated by agents, brokers, or third parties.
  • Collect and disclose information on the use of intermediaries in MA plan enrollments, including compensation details.
  • Provide public visibility into enrollment channels to help assess potential conflicts of interest or marketing practices.

Key provisions

  1. Reporting requirement (beginning plan years on/after January 1, 2028)

    • MA organizations must annually report to the Secretary of Health and Human Services:
      • For each individual enrolled in an MA plan offered by the organization:
      • Whether the enrollment was facilitated by an agent, broker, or other third party representing the organization.
      • If enrollment was via such intermediary:
        • The amount of compensation paid to the intermediary (if any).
        • The form of compensation (e.g., commission, fee, etc.).
      • The total amount of compensation paid to all intermediaries representing the organization for enrolling individuals in all MA plans offered by the organization for that year.
      • Any additional information about intermediaries as the Secretary may require.

  2. Transparency and public disclosure (beginning plan years after Jan 1, 2030)

    • The Secretary must:
      • Incorporate an indicator into the Chronic Condition Data Warehouse (CCW) to identify whether an individual enrolled in an MA plan was enrolled via an intermediary (as determined by the information reported under the above subsection).
      • Make publicly available on CMS’ website the information reported by MA organizations under the reporting requirements (clauses (ii) and (iii) of the subsection A).

Affected entities and individuals

  • Primary: Medicare Advantage organizations (MAOs) that contract under the Medicare Advantage program.
  • Individuals enrolled in MA plans (receiving a status indicator regarding intermediary enrollment from 2030 onward).
  • Intermediaries (agents, brokers, and third parties) involved in enrollments, as their compensation and involvement will be reported.
  • U.S. Centers for Medicare & Medicaid Services (CMS) and the Chronic Condition Data Warehouse (CCW) for data integration and public data publication.

Procedural and timeline aspects

  • Effective reporting start: Plan years beginning on or after January 1, 2028.
  • Data elements to be reported annually include intermediary identity (via enrollment source), compensation, and form of compensation, plus aggregate intermediary compensation data.
  • Transparency timeline: By plan year 2030, CMS must:
    • Add an enrollment-intermediary indicator to the CCW.
    • Publicly post the disclosed intermediary enrollment data on CMS’ website.
  • The bill is introduced by Rep. Alexandria Ocasio-Cortez and referred to the Ways and Means Committee and the Energy and Commerce Committee for consideration.

Potential impacts and considerations

  • Increased transparency around enrollment practices could influence MA marketing and sales strategies and reduce potential conflicts of interest.
  • MAOs may need enhanced data collection processes to accurately track enrollment sources and intermediary compensation.
  • Public access to intermediary data could affect consumer decision-making and market competition among MA plans.
  • Administrative burden and potential compliance costs for MAOs to compile and report detailed intermediary information annually.

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

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