WASHINGTON – U.S. Senators Bill Cassidy, M.D. (R-LA), Catherine Cortez Masto (D-NV), Elizabeth Warren (D-MA), and Marsha Blackburn (R-TN) introduced legislation to improve transparency of Medicare Advantage (MA) plans and ensure these plans are best serving the health care needs of America’s seniors. The Encounter Data Enhancement Act would require Medicare Advantage plans to report important information about how much they are actually paying for patient services and how much patients are responsible for paying out-of-pocket.
“Just as price transparency is good for patients, data transparency is good for the federal taxpayer,” said Dr. Cassidy. “Specifically, transparency allows taxpayers to better understand how the hundreds of billions of dollars going for Medicare programs is being used and answering the question of if the money can be better used.”
“American taxpayers are paying hundreds of billions of dollars for seniors to use Medicare Advantage plans, but the federal government still doesn’t know how much these plans are paying for patient services and how much patients are being forced to pay out-of-pocket,” said Senator Cortez Masto. “My bipartisan legislation will ensure these plans are transparent, helping us conduct appropriate oversight and provide seniors with the best possible health care coverage.”
“For years, Medicare Advantage plans have been using a long list of tricks to overcharge the government for coverage, while delaying and denying care for seniors,” said Senator Warren. “By strengthening data transparency, this bipartisan bill will empower lawmakers and regulators to rein in this fraud and abuse, and ensure taxpayer dollars are being used to deliver high-quality coverage for Medicare beneficiaries.”
“As the preference for Medicare Advantage grows among seniors because it provides more robust benefits beyond traditional Medicare, it becomes essential to encourage transparency in participating plans,” said Senator Blackburn. “This legislation accomplishes that by working to foster greater clarity in the billing practices of Medicare Advantage organizations, cultivating a more competitive and robust Medicare Advantage market for the benefit of future generations.”
In 2023, $454 billion (or 54%) of total federal Medicare spending went to Medicare Advantage—private insurance companies contracting with the federal government to provide Medicare coverage for over 30 million Americans. While the federal government already requires Medicare Advantage plans to report encounter data on services provided to beneficiaries, these records can be incomplete or lacking key information that is essential for combatting fraud.
The Encounter Data Enhancement Act would provide researchers and policymakers with a much clearer understanding of plan payments to providers and how much patients are required to pay for services. This legislation will help lawmakers conduct oversight of federal dollars going to Medicare Advantage plans, assess quality of care, and strengthen health care access for America’s seniors.