Medicare Advantage geographic adjustment update

Summary#

The Puerto Rico Medicare Advantage Fairness Act of 2026 is an introduced bill that would amend Title XVIII of the Social Security Act. It would require a geographic adjustment used to calculate Medicare Advantage payment benchmarks for Puerto Rico to match the adjustment for a Medicare Advantage payment area in the U.S. Virgin Islands, for specified years beginning on or after January 1, 2027. Its stated goal is to ensure appropriate geographic adjustments; that goal is not a guaranteed result.

  • For the covered years, Puerto Rico’s average geographic adjustment would have to equal the one applied to a U.S. Virgin Islands payment area.
  • The bill changes a formula used in Medicare Advantage payment calculations. It does not say that Puerto Rico’s full benchmark or plan payments must equal those in the U.S. Virgin Islands.
  • The bill is not law. It was introduced and referred to House committees; passage is uncertain.

What it means for you#

  • Medicare Advantage plans in Puerto Rico: The geographic adjustment used in calculating benchmarks for their payment areas would be tied to the adjustment for a U.S. Virgin Islands payment area, for the specified years.
  • People enrolled in Medicare Advantage in Puerto Rico: The bill does not directly change eligibility, covered benefits, or premiums. Any effect on plans or enrollees is not stated in the bill.
  • People in the U.S. Virgin Islands: The bill uses the adjustment for a U.S. Virgin Islands payment area as the comparison; it does not direct a change to that area’s adjustment.
  • Government: The bill changes the calculation required by federal law. It does not name an agency, create a new office, or set out a process for carrying out the change.

Money#

No publicly available information on the bill’s cost.

  • The bill could affect federal Medicare Advantage payments by changing a geographic adjustment used in benchmark calculations. It gives no dollar estimate or estimate of the direction or size of any change.
  • The bill does not specify new staffing, fees, fines, or an appropriation.

What is unclear#

  • The parent Act is not supplied, so the current formula and the years referred to in the law’s existing clause (ii) could not be verified.
  • The bill does not explain how the geographic adjustment is calculated or why the U.S. Virgin Islands adjustment is the chosen comparison.
  • It does not estimate how the change would affect benchmarks or plan payments.
  • The bill does not state how the calculation would be administered, or whether other existing payment rules would affect the result.

Case for#

  • A possible argument for the bill is that using the same geographic adjustment for Puerto Rico and a U.S. Virgin Islands payment area would make this part of the benchmark calculation more consistent between the two territories.
  • Setting the adjustment in law could give Medicare Advantage plans and the government a clear rule for the specified years.

Case against#

  • One concern is that the bill requires the same adjustment without explaining whether it fits the costs or circumstances of both places.
  • It is unclear whether the change would raise or lower federal payments, or by how much.
  • The bill does not explain how the adjustment would be administered or how it would interact with the rest of the existing benchmark calculation.