H.R. 4093: Apples to Apples Comparison Act of 2025

The Apples to Apples Comparison Act of 2025 aims to enhance transparency in Medicare expenditures by requiring the Secretary of Health and Human Services to publish detailed information about Medicare spending. Here’s a breakdown of the key points of the bill:

Information Publication Requirement

Beginning in 2025, the Secretary must:

• Publish spending information on the Medicare program on a public website, specifically the Centers for Medicare & Medicaid Services (CMS) site.
• Provide data disaggregated by county and Metropolitan Statistical Area (MSA) for clearer comparison.
• Include total and average expenditures for items and services furnished to Medicare beneficiaries, specified by categories of individuals, for both historical and projected periods.

Categories for Reporting

The expenditure reports will break down data for the following categories of individuals:

• Individuals entitled to benefits under Medicare Part A but not enrolled in Part B.
• Individuals enrolled in Part B but not entitled to benefits under Part A.
• Individuals entitled to benefits under both Part A and Part B, but not enrolled in Medicare Advantage plans.
• Prescription drug plan enrollments under Medicare Part D will also be considered for reporting.

Subsequent Analysis by MedPAC

Starting in 2026, the Medicare Payment Advisory Commission (MedPAC) will conduct an annual retrospective analysis comparing average expenditures for:

• Individuals enrolled in Medicare Advantage plans with those entitled to benefits under Parts A and B who are not enrolled in such plans.

This analysis aims to offer insights into the differences in expenditures and benefits provided by Medicare Advantage compared to Traditional Medicare.

Trustee Reports on Expenditures

Beginning in 2026, the Boards of Trustees for the Medicare trust funds will also be mandated to include:

• Aggregate and average expenditures under Medicare, categorized as outlined above.
• Disaggregated expenditure data where practicable, to provide more granularity in understanding Medicare spending trends.

Overall Goals of the Bill

The primary objective of the Apples to Apples Comparison Act is to allow for better public understanding and comparison of Medicare expenditures across different regions and demographic groups. By mandating the publication of this data, the bill aims to create a more informed environment for stakeholders involved in Medicare, including beneficiaries, policymakers, and healthcare providers.

Relevant Companies

None found