H.R. 10747: Puerto Rico Medicare Advantage Fairness Act of 2026

This bill would change how Medicare Advantage payments are calculated for plans in Puerto Rico starting in 2027.

What it does

Under current law, Medicare Advantage benchmark payments can be adjusted based on local geographic factors. This bill would require that, for Puerto Rico, the average geographic adjustment used in those calculations be the same as the adjustment used for Medicare Advantage areas in the U.S. Virgin Islands.

Plain-language effect

In simple terms, the bill would make the payment formula for Medicare Advantage plans in Puerto Rico use a geographic adjustment rule tied to the U.S. Virgin Islands instead of the current Puerto Rico-specific treatment. The purpose is to change how much Medicare pays plan insurers in Puerto Rico when setting benchmark amounts for those plans.

Timing

The change would apply to payment years beginning on or after January 1, 2027.

Who could be affected

The bill would directly affect Medicare Advantage plans operating in Puerto Rico, as well as the federal Medicare program’s payment calculations for those plans. It could also indirectly affect Puerto Rican Medicare beneficiaries if plan offerings, premiums, benefits, or insurer participation change as a result of the revised payment levels.

Relevant Companies

None found