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Medicare Advantage Integrity Act of 2025
To amend title XVIII of the Social Security Act to establish a floor in Medicare Advantage benchmark rates for regions with low Medicare fee- for-service penetration.
Summary
This bill modifies how Medicare Advantage payment rates are calculated, particularly in areas with low traditional Medicare enrollment. It establishes a minimum floor of 0.70 for the average geographic adjustment factor used in calculating Medicare Advantage benchmark rates, effective starting in 2026. This ensures that Medicare Advantage payment rates in certain regions do not fall below a specified threshold. The bill also requires that at least 50 percent of any increased payments resulting from this change be directed toward payment for basic benefits covered by Medicare Advantage plans.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
2 cosponsors
Actions (2)
- Nov 12, 2025 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. · house
- Nov 12, 2025 Introduced in House
Similar bills (6)
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Text versions (1)
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Full text
IN THE HOUSE OF REPRESENTATIVES
November 12, 2025
Mr. Hernandez (for himself, Ms. Salazar, and Mr. Soto) introduced the following bill; which was 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
A BILL
To amend title XVIII of the Social Security Act to establish a floor in Medicare Advantage benchmark rates for regions with low Medicare fee- for-service penetration.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Medicare Advantage Integrity Act of 2025”.
SEC. 2. ADDRESSING DISPARITIES IN MEDICARE ADVANTAGE BENCHMARK LEVELS BASED ON PENETRATION.
(a) In General.—Section 1853(n) of the Social Security Act (42 U.S.C. 1395w-23(n)) is amended—
(1) in paragraph (1)(B), by striking “subsequent year” and inserting “subsequent year, subject to paragraph (6),”; and
(2) by adding at the end the following new paragraph:
“(6) Average geographic adjustment floor.—For 2026 and subsequent years, when calculating the adjusted average per capita cost under section 1876(a)(4) for the purposes of establishing the base payment amount specified in paragraph
(2)(E), the average geographic adjustment shall not be less than 0.70 for any area. For the purposes of the previous sentence, the Secretary may define the term ‘average geographic adjustment’ under subparagraph (A) by program instruction or otherwise.”.
(b) Ensuring Plan Payments Flow to Providers and Patients.—Section 1854(a)(6) of the Social Security Act (42 U.S.C. 1395w-24(a)(6)) is amended by adding at the end the following new subparagraph:
“(C) Ensuring increased payments support care.— With respect to the increase in blended benchmark amount attributable to the application of section 1853(n)(6), no less than 50 percent shall be directed toward payment for basic benefits as defined in section 1852(a)(1)(B).”. <all>
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