By Neil Patil and Erica Socker
With Medicare Advantage (MA) becoming the dominant form of coverage in Medicare, understanding MA is central to understanding the cost and quality of care that Medicare beneficiaries receive, as well as their experience in the program. The growth in MA also has important implications for Medicare spending. The Medicare program pays substantially more for MA enrollees than it does for similar beneficiaries enrolled in traditional Medicare, and will pay MA plans a projected $615 billion this year for benefits covered under Parts A and B.
Despite the important role MA plays in today’s Medicare program, policymakers, Medicare beneficiaries, and researchers face major gaps in understanding how federal dollars are used by MA plans, the results these plans achieve, and their impact on beneficiaries and the broader health care system. The lack of transparency undermines effective oversight of the Medicare program and efforts to understand the value MA provides to beneficiaries and taxpayers. Limited information about key differences between MA plans, such as their use of prior authorization, also hinders beneficiaries’ ability to navigate the complex set of coverage options and select a plan that reflects their preferences.
In July 2026, the House Energy and Commerce and Ways and Means Committees debated and advanced a slate of bills aimed at requiring more transparency and reporting from MA plans on key aspects of the program, including supplemental benefits, payments and cost sharing, medical loss ratios, and prior authorization. The committee markups represent an unusually strong bipartisan push for greater transparency and oversight of MA. The number and scope of MA policies considered are notable, especially given that nearly all of the bills advanced without a single opposing vote. The bipartisan support suggests a growing recognition that the large amount of federal spending and MA’s role in shaping enrollees’ care merit additional reporting in targeted areas that are foundational to understanding and overseeing the MA program.
We discuss the information gaps these bills would help fill, if passed, and opportunities to improve policymakers’ ability to assess and oversee the performance of the MA program and beneficiaries’ ability to choose a plan that meets their needs.
Improving Transparency: Supplemental Benefits
Why does it matter?
MA plans use rebate dollars paid to them by the federal government to pay for supplemental benefits (such as hearing aids, dental care, gym memberships, and over-the-counter allowances) and reduce out-of-pocket costs for enrollees. Rebates to MA plans have more than doubled in the past decade and are expected to average about $2,660 per enrollee in 2026—an all-time high—as the result of coding intensity, favorable selection, and other factors that have led to more generous MA benchmarks and higher payments. Special needs plans receive even larger rebates of $3,300 per enrollee; they expect to spend more than $2,500 of that on non-Medicare covered benefits. Last year, Medicare’s rebate payments to plans totaled $84 billion.
There is little publicly available information on how MA plans use their rebate dollars, the supplemental benefits enrollees use and their cost, or the value the benefits provide to enrollees or taxpayers, despite the large amount the Medicare program spends on rebates each year and plans’ extensive marketing of supplemental benefits to enrollees.
What would the bills do?
The bill advanced by the House Energy and Commerce Committee would require plans to report enrollee-level use and spending for supplemental benefits. The Ways and Means Committee advanced a similar bill; however, it appears to call for plan-level rather than enrollee-level reporting. Both bills would take steps to improve the public availability of the supplemental benefit data, including requiring CMS to make the data available to researchers and to publicly post a file with information on supplemental benefit use, plan spending on these benefits, and the amount enrollees pay when they use the benefits.
What are the policy implications and considerations?
The bills build on existing CMS efforts that begin to fill gaps in supplemental benefit information. In 2024, CMS acted to increase and improve plan reporting of enrollee-level information on supplemental benefit use and cost in encounter data submissions, although there are known challenges with the reliability and completeness of the encounter data. Beginning in 2023, CMS has also required MA plans to report how much they spend on certain categories of supplemental benefits (at the contract-level) in their medical loss ratio reporting, but the data offer limited insight into how many enrollees use the benefits, the cost per use, and other important factors.
The House bills’ reporting requirements would support greater oversight over how Medicare dollars are spent and improve policymakers’ ability to assess the value of the large federal investment in supplemental benefits. The data the requirements yield will be most meaningful for oversight and research efforts if they are provided at the enrollee level and can be linked with data on enrollee outcomes and utilization to allow researchers to assess whether specific benefits are well-targeted to enrollees based on need and whether their use improves enrollee health outcomes.
Improving Transparency: MA Plan Payments and Enrollee Cost-Sharing
Why does it matter?
While CMS currently collects certain billing information through the encounter data system, including some payment information, there are significant gaps in our understanding of MA payments to providers and enrollee out-of-pocket costs. For example, while the potential for lower out-of-pocket costs can be an important draw for MA enrollees, existing transparency gaps make it difficult to assess how much enrollees actually pay out of pocket for health care services and how those costs vary across plans. Information on payments and enrollee spending is omitted from the data provided to researchers.
In addition, many non-claims-based payments, such as payments made through capitated and value-based arrangements, are not captured in the encounter data, although they are common in MA and important to understanding overall payment levels. Information on the amount and structure of these arrangements could help policymakers assess their implications for other aspects of the program, including medical loss ratio calculations, coding incentives, and plan and provider behavior.
What would the bills do?
The Energy and Commerce and Ways and Means Committees advanced legislation that would require MA plans to report additional information in their encounter data on payments, enrollee cost sharing, and ownership relationships with certain entities. First, the legislation would require MA plans to include the billing amount for each item or service furnished to an enrollee, as well as what the enrollee paid out of pocket. The Energy and Commerce Committee version of the bill would also require plans to report payments for care provided under value-based or capitated arrangements using a methodology established by the Secretary. Both versions of the bill require MA plans to indicate when an enrollee receives an in-home health risk assessment from an entity they share common ownership with.
What are the policy implications and considerations?
This information is essential to understanding payments to providers—an important driver of MA plans’ costs—in addition to government and enrollee spending. In combination with the supplemental benefit reporting described above, these data would provide a more complete picture of how MA plans use the federal dollars they receive, and the costs associated with the care and benefits provided to enrollees. The usefulness of these new data will depend on their accuracy and completeness. MA encounter data have well-documented challenges with reliability and completeness, making continued efforts to assess and enforce plan compliance with reporting requirements important to ensuring the new information can support meaningful research and oversight.
Improving Transparency: How MA Plans Spend Premium Dollars
Why does it matter?
The medical loss ratio (MLR) is intended to protect consumers and taxpayers by requiring that MA plans spend at least 85% of premium revenue on providing care to enrollees and quality improvement activities. As insurers have increasingly acquired physician practices, home health agencies, and other health care entities over the past decade, experts have raised concerns that vertical integration may weaken the effectiveness of the MLR requirement. There is the potential for vertically integrated MA plans to inflate the prices they pay to their owned entities above competitive market rates, allowing plans to report higher expenses for the purposes of MLR while retaining those profits within the same parent company. Existing data are insufficient to assess the extent to which this potential MLR gaming is occurring and to effectively enforce the MLR requirements.
What would the bills do?
Both committees advanced bills to increase the information publicly available on health plans’ MLRs. The legislation would require MA plans to post on their websites, in a consumer-friendly format, the components that make up their MLR. This includes the amount of premium revenue each plan collects, the claims costs they incur when enrollees receive care, and the amount spent on non-claims costs, as well as their MLR itself (i.e., the percent of premium revenue spent on claims and other qualifying expenses).
What are the policy implications and considerations?
These bills would make information about how plans are spending premium dollars and their MLR more accessible for consumers. However, they would not provide additional insight into how vertical integration may be affecting MA plans’ pricing and MLR compliance. To strengthen oversight, policymakers could consider expanding the MLR transparency provision to collect information on MA plans’ related-party entities and their payments to those entities. This information could be collected more narrowly in the context of MLR reporting or as part of broader efforts to increase the transparency of MA plans’ ownership relationships and payments to health care entities they contract with given the impact that widespread, insurer-led vertical integration can have not only on MLR compliance, but also on coding intensity, payments, patient referrals, and other outcomes.
Improving Transparency: Prior Authorization, Denials, and Appeals
Why does it matter?
Nearly all MA enrollees (99%) are in plans that require prior authorization for certain services, yet there is limited information about how plans use prior authorization, the rates at which they deny requests, and how important prior authorization metrics differ across plans. CMS has taken steps in recent years to increase prior authorization transparency, implement new enrollee protections, and streamline prior authorization processes. This year, MA organizations began publicly reporting certain organization-level prior authorization metrics annually on their plan websites, although these data have significant shortcomings that limit their usefulness.
What would the bills do?
Both the Energy and Commerce and Ways and Means Committees advanced versions of the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would streamline prior authorization requirements in MA and increase transparency requirements for plans. The legislation has generally received broad bipartisan support in Congress, with a previous version unanimously passing the House of Representatives in 2022.
The Improving Seniors’ Timely Access to Care Act requires more granular plan-level reporting of prior authorization requests, denials, and response times, as well as additional information such as disclosing whether artificial intelligence or other technology was used in making prior authorization decisions. Under the bill, MA organizations must report this information to CMS, which would be required to post it on its website. Displaying the information in a centralized location rather than on individual plan websites could allow beneficiaries to more easily access and compare information across plans.
What are the policy implications and considerations?
The transparency provisions included in the legislation could provide policymakers, beneficiaries, researchers, and providers with better information on how prior authorization is used across MA plans. More granular plan-level information could be particularly useful to beneficiaries because prior authorization practices may affect their experience accessing care and be an important consideration when comparing and selecting coverage options. For policymakers, these more detailed data could also support oversight and enforcement of existing prior authorization requirements and help identify where additional guardrails may be needed to protect enrollees’ access to needed care.
Conclusion
MA now accounts for the majority of enrollment and spending in the Medicare program. Yet, in contrast to the traditional Medicare program where the government has broad access to standardized data on utilization, cost, and quality, there is limited information on core features of MA that affect beneficiary outcomes and experiences, as well as Medicare spending. The bipartisan legislation that the House Energy and Commerce and Ways and Means Committees recently advanced to the House floor would help improve transparency in the MA program, particularly when coupled with strong enforcement mechanisms and other measures to increase the usefulness of the information.