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HR5854FEDERALIN_COMMITTEE
High Impact

Medicare Advantage Consumer Protection and Transparency Act

December 17, 2024

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Where This Stands

Introduced
Committee
Floor Vote
Passed
Signed

Currently IN_COMMITTEE. The next step in the legislative lifecycle is Floor Vote.

Version history

Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.

View official text →

The Frame

What this does

This legislation aims to increase transparency for Medicare Advantage enrollees by forcing insurers to publicly report how often they deny claims and how they manage their provider networks, directly impacting the oversight of private insurance plans serving millions of seniors.

Who is mentioned in the record

Potentially affected actors named in the source documents. Mention is not a position.

Medicare Advantage organizations

These organizations must implement new data collection and reporting systems and face financial penalties for non-compliance.

Medicare Advantage enrollees

Enrollees will have access to more public information regarding plan performance, coverage denials, and provider network availability.

What changed

Current stage: IN_COMMITTEE.

What's next

Floor Vote.

Background

  • Medicare Advantage, also known as Medicare Part C, is an alternative to original Medicare provided by private insurance companies approved by the federal government. context

Summary

This bill requires Medicare Advantage plans to submit detailed data on , coverage denials, and provider networks to the federal government. Plans that fail to provide accurate and complete information will face monthly payment reductions of up to 10 percent.

Key Facts

You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.

Why It Matters

This legislation aims to increase transparency for Medicare Advantage enrollees by forcing insurers to publicly report how often they deny claims and how they manage their provider networks, directly impacting the oversight of private insurance plans serving millions of seniors.

Frequently Asked Questions

How will this affect my Medicare Advantage plan?
Your plan will be required to report more detailed data to the government regarding how they handle claims, denials, and provider networks. This is intended to improve public transparency.
What happens if a plan does not follow these new reporting rules?
The plan will face monthly payment reductions ranging from 5% to 10% until they submit the required, accurate information.
Will I be able to see this information?
Yes, the bill requires the Secretary of Health and Human Services to publicly report the submitted data, and provider network information will be available on an internet site.

News Coverage

No news coverage found yet. Articles are indexed twice daily.

Lobbying Activity

AARP

$4,110,000

2026

HEALTH ISSUESMEDICARE/MEDICAIDLAW ENFORCEMENT/CRIME/CRIMINAL JUSTICEPHARMACY

P.L. 119-21, One Big Beautiful Bill Act H.R. 8867, Planning for Long-term Aging Needs (PLAN) Act H.R. 5861, Legacy Act of 2025 H.R. 9393, the Lower Costs, More Transparency Act. H.R. 9396, the Prior Authorization Accountability Act. S. 4916, the Aging with Artificial Intelligence Act. H.R. 8100, Safe Staffing Saves Lives Act. S. 3886, Nurses Belong in Nursing Homes Act. H.R. 6766/S. 3492, the Essential Caregivers Act of 2025. H.R. 7966/S. 4118, Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act. S. 2120, the Older Americans Act Reauthorization Act of 2025 H.R. 5575, the Firefighters Assisting Seniors to Emergency Response (FASTER) Act of 2025. H.R. 3954/S. 4641, Improving Access to Medicare Coverage Act. H.R.5554/S.2831, Stand Strong for Medicare Act. S. 3439/H.R. 6735, Connecting Caregivers to Medicare Act and efforts related to the bill S. 1227/H.R. 2491, Alleviating Barriers for Caregivers Act S. 668/H.R. 3183, Supporting Access to Falls Education and Prevention and Strengthening Training Efforts and Promoting Safety Initiatives (SAFE STEPS) for Veterans Act of 2025 CMS-1851-P, Hospice Proposed rule. CMS-1843-P, Skilled Nursing Facility Proposed rule. CMS-1844-P, Home Health Proposed rule. No bill number. Health care transparency. No bill number. Discussed use of artificial intelligence and health data technology. No bill number. Discussed health-related policies and activities around the fall respiratory virus season. No bill number. Discussed health insurance affordability proposals. No bill number. Discussed Nursing Home staffing standards, safety, and quality. No bill number. Discussed Nursing home transparency and ownership requirements. No bill number. Discussed home health, hospice, and long-term care. No bill number. Discussed falls prevention. No bill number. Discussed social isolation. No bill number. Discussed HUD Assisted Living Requirements No bill number. Discussed family caregiving. No bill number. Discussed AARP paper on Medicare Caregiver Training Services. No bill number. Discussed Medicaid community engagement interim final rule, including the family caregiver exemption. No bill number. Discussed the paid direct care workforce in long-term care. No bill number. Discussed the unaffordability of long-term care. No bill number. Discussed Money Follows the Person Rebalancing Demonstration Program and Medicaid HCBS spousal impoverishment protections. No bill number. Discussed Medicaid fraud and family caregivers, Medicaid self-direction programs. No bill number. Discussed sandwich generation family caregiver hearing and submitted a statement for the record discussing family caregivers and sandwich generation caregivers, programs that support them, AARP caregiving resources, and federal policies to support sandwich generation caregivers and caregivers more broadly. No bill number. Discussed long-term care. No bill number. CMS-2453-NC; Medicaid Program; 2028 Medicaid Home and Community-Based Services Quality Measure Set Submitted comments No bill number. Discussed expanding access to home care. No bill number. Discussed the increasing cost of home care No bill number. Discussed HSA use for telehealth chronic care management services/subscriptions. No bill number. Discussed artificial intelligence and technology

Sponsors

Discoveries

Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.

policy shift100% confidence

Shift to Plan-Level Reporting

The bill explicitly moves reporting requirements from the contract level to the plan level, increasing the granularity of oversight for the Secretary of Health and Human Services.

Connected Entities

organizationSecretaryThe Secretary of Health and Human Services, responsible for administering the MeMap →
organizationMedicare Advantage organizationsThe entities offering Medicare Advantage plans.Map →
personPorter, Ms.Lead sponsor of the bill in the House of Representatives.Map →
personDoggett, Mr.Co-sponsor of the bill in the House of Representatives.Map →
personDeGette, Ms.Co-sponsor of the bill in the House of Representatives.Map →
organizationUnited States Government Publishing OfficeSource of the Congressional BillMap →
personSchakowsky, Ms.Co-sponsor of the bill in the House of Representatives.Map →

Analysis Score

0–100
  • Significance85
    How much this matters to a regular citizen
  • Controversy60
    Intensity of disagreement among stakeholders
  • Entertainment10
    Compellingness for a non-policy-wonk reader
  • Buzz25
    Current news / social attention level

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