H.R. 6031: Medicare Advantage Integrity Act of 2025

This bill, known as the Medicare Advantage Integrity Act of 2025, aims to modify the way Medicare Advantage benchmark rates are established, particularly in regions where traditional Medicare services (fee-for-service) are less common. The key components of the bill are as follows:

Benchmark Rate Adjustments

The bill proposes an amendment to the Social Security Act, specifically targeting the calculation of average geographic adjustments used to determine the benchmark payment amounts for Medicare Advantage plans. It introduces a floor for the geographic adjustment rates:

• Starting in 2026, the average geographic adjustment for any area will not be less than 0.70. This means that even if a region has low participation in the traditional Medicare fee-for-service program, the benchmark payment rates for Medicare Advantage will be protected from dropping below this level.

Allocation of Payments

Additionally, the bill emphasizes that at least 50% of any increase in the benchmark payment amount that results from this geographic adjustment must be used to support basic healthcare benefits for patients enrolled in Medicare Advantage plans. This aims to ensure that the increased funds benefit providers and patients directly:

• Basic benefits are defined as the essential services covered by a Medicare Advantage plan, ensuring that the funding directly contributes to the healthcare services provided.

Overall Purpose

The overall intent of the Medicare Advantage Integrity Act of 2025 is to address disparities in the funding and resources available to Medicare Advantage plans in areas where traditional Medicare is less utilized, promoting more equitable healthcare financing and support for patients in those regions.

Relevant Companies

• HUM - Humana Inc. may see changes in payment structures for its Medicare Advantage plans, influencing its overall revenue strategies.
• UNH - UnitedHealth Group Incorporated could experience shifts in its Medicare Advantage plan reimbursements, affecting their financial projections and service offerings.
• ANTM - Anthem, Inc. might also be impacted by alterations in benchmark rates which could require adjustments in its Medicare plan pricing and benefit structures.