H.R. 9644: Medicare Advantage MLR Transparency Act

This bill would require Medicare Advantage insurers to be more transparent about how they spend premium revenue and how much they pay out in claims.

What Medicare Advantage plans would have to disclose

Starting with plan years beginning on or after January 1, 2029, each Medicare Advantage organization would have to submit and post, in a consumer-friendly format, information for each plan it offers showing:

• Total revenue for the plan.
• How much revenue was spent on claims and the percentage of revenue that represents.
• How much revenue was spent on non-claims costs and the percentage of revenue that represents.
• The difference between the MLR numerator and denominator under Medicare Advantage rules.
• That difference as a percentage of revenue.

The bill also lets the Secretary of Health and Human Services require this information to be published in the aggregate across all Medicare Advantage plans offered by the same company, not just plan-by-plan.

How the information would be treated

To calculate these amounts, the bill says existing Medicare Advantage medical loss ratio rules would be applied at the plan level instead of the current references to contracts. In practical terms, this is meant to align the reporting with individual plan performance.

Standardized presentation of benefit information

The bill also changes Medicare Advantage rules so that certain benefit information provided electronically, beginning with the first plan year that starts at least one year after enactment, must be presented in a uniform format to the greatest extent practical. That format would match the one used for certain employer health plans and health insurance issuers under the Public Health Service Act.

Overall effect

In plain terms, the bill is designed to make it easier for consumers, regulators, and others to compare Medicare Advantage plans by showing more clearly:

• how much money a plan takes in,
• how much goes to medical claims,
• how much goes to administrative or other non-claims costs, and
• how those figures compare across plans and companies.

Relevant Companies

• UNH — UnitedHealth Group, through its UnitedHealthcare business, is one of the largest Medicare Advantage insurers and would likely have to provide the required disclosures for its plans.
• HUM — Humana is heavily involved in Medicare Advantage and would likely be directly affected by the new reporting requirements.
• CNC — Centene offers Medicare Advantage plans in some markets and would likely need to comply with the added transparency rules for those plans.
• EHIC — Elevance Health participates in Medicare Advantage and would likely face new plan-level disclosure obligations.
• CVS — CVS Health, through Aetna, offers Medicare Advantage plans and would likely be affected by the new reporting and formatting requirements.
• CI — Cigna has Medicare Advantage operations and would likely need to update its disclosures and plan information materials.