This bill mandates increased data transparency from Medicare Advantage plans regarding the supplemental benefits they offer, making utilization and payment data available to the public and researchers.
Jennifer McClellan
Representative
VA-4
This bill amends the Social Security Act to mandate greater data transparency regarding supplemental benefits offered under Medicare Advantage plans. It requires Medicare Advantage organizations to report detailed information on benefit eligibility, type, utilization, and costs starting in 2029. This data will then be made publicly available annually for research and analysis, while ensuring strict protection of individual member privacy.
Medicare Advantage Plans Must Detail Supplemental Benefits by 2029: What This Means for Your Gym Membership and Dental Coverage
This legislation amends Title XVIII of the Social Security Act, mandating that Medicare Advantage (MA) plans significantly increase the transparency around the extra benefits they offer. Starting with plan years beginning on or after January 1, 2029, MA organizations must report detailed data to the government about their supplemental benefits—think dental, vision, gym memberships, and transportation services. This isn't just a list of what’s available; plans must now detail who is eligible, the types of benefits offered, how much these benefits are actually being used by members, and the total payouts.
The Fine Print on Your MA Perks
Currently, it can be tough for consumers and researchers to compare the true value of supplemental benefits across different MA plans. Plan A might advertise a great dental benefit, but how many members actually use it, and how much does the plan really pay out? This bill, under SEC. 1, forces MA plans to open their books on these perks. For the average person shopping for an MA plan, this means that by the time this data starts flowing in 2029, future plan comparisons should be much more informed. You won't just see that a gym membership is offered; you might eventually see how many people in similar plans actually use it, helping you gauge if that benefit is real or just marketing fluff.
Public Data Dump for Policy Wonks and Consumers
The most important part of this bill for transparency is what happens after the MA plans submit their data. The Secretary of Health and Human Services is required to make this information available to researchers and the public every year. Specifically, by the first Monday in October annually, the data must be accessible for research, and by October 1st, a public-use file must be posted on the Centers for Medicare & Medicaid Services (CMS) website. This move is a big win for policy analysts and consumer advocates, who can finally evaluate whether these supplemental benefits are truly effective and being utilized by the people who need them.
The Trade-Off: Privacy vs. Transparency
While this increased transparency is a major benefit, the legislation is careful to include a critical safeguard. The Secretary must implement strict procedures to ensure that when the data is released, no individual member's private information can be identified. This is crucial: the government wants to show the patterns of benefit usage—like how many members used the transportation benefit—without revealing who used it. This balances the need for public oversight with the absolute necessity of protecting patient privacy. For the MA organizations themselves, this means an increased administrative burden starting in 2029, as they will have to build the systems necessary to capture and report this highly detailed utilization data.