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Local Medicare Spending Transparency

Full Title:
Apples to Apples Comparison Act of 2025

Summary#

This bill requires the Department of Health and Human Services (through CMS) to publish detailed Medicare spending data by county and metropolitan area. It also directs the Medicare Payment Advisory Commission (MedPAC) and the Medicare Trustees to produce new analyses and broken-down expenditure figures comparing Medicare Advantage (MA) plans and traditional fee-for-service (FFS) Medicare.

  • Main change: CMS must publish, in machine-readable files, monthly total and average Medicare expenditures by county and Metropolitan Statistical Area (MSA), starting in 2025, broken down into many enrollment categories (parts A, B, C, D, supplemental coverage, federal plans, etc.).
  • MedPAC change: MedPAC must annually analyze average expenditures for MA enrollees versus comparable FFS enrollees starting in 2026 and publish the data, methods, and responses to public comments.
  • Trustees change: The Boards of Trustees for the Medicare trust funds must include aggregate and average expenditure information by major enrollment groups in their annual reports starting in 2026 and disaggregate public tables when practicable.
  • Historical coverage: CMS must include, in the 2025 publication, enrollment information for each year back to 2015, broken down by county and MSA for the listed categories.
  • Data and format: Data must be machine-readable (so it can be reused by researchers and the public) and MedPAC must publish data in a way that allows replication while protecting individual confidentiality.

What it means for you#

  • Medicare beneficiaries

    • You may be reflected in more detailed local spending statistics (county/MSA) depending on your enrollment (parts A, B, C, D, supplemental).
    • The bill requires protections for personal confidentiality, but more local detail could mean some data suppression or aggregation to protect privacy.

  • Researchers, journalists, and policymakers

    • You will get more granular, machine-readable monthly spending data by county and MSA and by many enrollment categories. This makes it easier to compare spending across places and between MA and FFS.
    • MedPAC will publish analyses and the underlying data and methods, which should help replication and critique.

  • Medicare Advantage plans and insurers

    • Their average per-enrollee spending will be subject to regular public comparison with FFS spending.
    • Data releases could affect negotiations, policy debates, and public perceptions of plan value.

  • CMS / HHS and federal agencies

    • Agencies must collect, process, protect, and publish more detailed data on a new schedule. They must maintain confidentiality and prepare historical and projected series.

  • Taxpayers

    • The bill aims to make spending patterns more transparent. It could inform policy choices about Medicare costs and program design.

Expenses#

No publicly available information.

  • The bill will likely require CMS and MedPAC to spend staff time and money to prepare, validate, store, and publish detailed, county-level monthly files and historical back-series. This could include IT, data processing, and privacy-protection work.
  • Trustees’ offices may incur additional time and publishing costs to disaggregate and present expenditure tables.
  • The bill does not specify new fees or funding to cover these tasks.

Proponents' View#

  • The bill appears intended to increase transparency of Medicare spending at a local level and across types of coverage. This could help lawmakers, researchers, and the public compare costs “apples to apples.”
  • Publishing machine-readable data and MedPAC’s methods and data could allow independent replication and better policy analysis.
  • Requiring historical series back to 2015 and regular projections adds context to spending trends and future expectations.

Opponents' View#

  • One concern is administrative cost and workload: producing monthly, county-level, multi-category data and historical back-series may be expensive and time-consuming for CMS, MedPAC, and the Trustees.
  • The bill gives many granular categories. This could create privacy risks when local populations or subgroups are small. The bill requires confidentiality protections but does not detail how small cell suppression will be handled.
  • It is unclear how the Secretary will define the length of the projected period (up to 5 years) or the exact methods for producing projections, which could affect comparability.
  • For the MedPAC comparisons, the commission must account for risk scores (HCC) but must not account for “favorable selection” differences. It is unclear how excluding favorable selection will affect the fairness or interpretation of MA vs FFS comparisons.