MedPAC analysis of Medicare Advantage and fee-for-service expenditures

Section 1805(b) of the Social Security Act (42 U.S.C. 1395b–6(b)) is amended by adding at the end the following new paragraph: (12) Analysis of Medicare Advantage and fee-for-service expenditures (A) In general The Commission shall, as part of the report described in paragraph (1)(C) submitted for each year (beginning with 2027), include a retrospective analysis of average expenditures under this title for individuals enrolled in a Medicare Advantage plan under part C compared to average expenditures under this title for individuals entitled to benefits under part A and enrolled under part B who are eligible to enroll under such a plan but who are not so enrolled. (B) Considerations In preparing each analysis described in subparagraph (A), the Commission shall— (i) use data provided by the Chief Actuary of the Centers for Medicare & Medicaid Services and the Boards of Trustees of the Federal Hospital Insurance Trust Fund established under section 1817 and the Federal Supplementary Medical Insurance Trust fund established under section 1841 and such other data as the Commission determines appropriate; (ii) take into account— (I) differences in value provided under Medicare Advantage plans compared to the value provided under parts A and B, such as the existence of out-of-pocket expenditure caps, supplemental benefits available under such plans, and the integration of benefits for covered part D drugs under certain such plans; (II) demographic differences of individuals enrolled in Medicare Advantage plans compared to individuals entitled to benefits under part A and enrolled under part B who are not enrolled in such a plan; and (III) differences in HCC risk scores; and (iii) not take into account any favorable selection differences with respect to enrollment in such plans. (C) Publication requirements With respect to each analysis described in subparagraph (A), the Commission shall— (i) make public all data used in preparing such analysis in a manner that— (I) allows replication of such analysis; and (II) protects the confidentiality of personal information of individuals entitled to benefits under part A and enrolled under part B; (ii) not later than 60 days prior to the submission of such analysis, make public the methodology used to conduct such analysis and allow at least 30 days for public comment on such methodology; and (iii) make public a response to each such comment received on the methodology prior to or concurrent with the submission of such analysis..