Medicare Advantage Benchmark Floor

Summary#

The Medicare Advantage Integrity Act of 2025 would amend title XVIII of the Social Security Act; it would not create a separate program. Its stated goal is to address differences in Medicare Advantage benchmark levels tied to Medicare fee-for-service enrollment.

  • Starting in 2026, the average geographic adjustment used to set a base payment amount could not be below 0.70 for any area.
  • The Secretary may define “average geographic adjustment” by program instruction or another method.
  • At least 50% of the increase in the blended benchmark amount caused by the new floor must be directed toward payment for basic benefits.
  • The supplied status lists the bill as referred to House committees, not enacted. Its passage is uncertain.

What it means for you#

  • Medicare Advantage plans: The bill would set a minimum adjustment in the benchmark calculation. It does not specify which plans or areas would receive a higher benchmark.
  • People enrolled in Medicare Advantage: The bill would not directly change who is eligible or set out new benefits. It requires a share of any increase attributable to the floor to go toward payment for basic benefits, but does not say how that must affect members’ care or costs.
  • Providers: The bill does not set out a process for providers to receive payments. It requires a share of the increase to be directed toward payment for basic benefits.
  • Taxpayers: The bill does not create a tax or fee. Any effect on public spending is not estimated in the supplied material.

Money#

No publicly available information on the bill’s cost estimate.

  • The bill does not appropriate a stated amount. As an inference, raising the benchmark calculation in some areas could increase federal payments, but the bill gives no estimate.
  • At least half of the increase attributable to the floor must be directed toward payment for basic benefits.
  • The bill sets no new tax, fee, or fine.

What is unclear#

  • The supplied material does not include the current text of the Social Security Act. I could not verify how the bill would interact with existing benchmark rules or payment requirements.
  • The bill’s title refers to areas with low fee-for-service enrollment, but its operative rule applies to any area. It does not define “low” or limit the floor to those areas.
  • The bill does not explain how the Secretary would define “average geographic adjustment,” or how often that definition could change.
  • It does not say who must direct the required 50% share, how compliance would be checked, or what happens if the requirement is not met.
  • No estimate is provided for which areas or plans would be affected, the size of any benchmark increase, or the resulting spending.

Case for#

  • A minimum adjustment could reduce differences in benchmark levels across areas, which appears to be the problem the bill is designed to address.
  • Setting a clear floor may provide a more consistent basis for calculating Medicare Advantage benchmarks.
  • Requiring at least half of the increase to support payment for basic benefits ties part of the change to care rather than leaving the full increase unrestricted.

Case against#

  • The bill does not limit the floor to areas with low fee-for-service enrollment, despite that focus in its title and stated purpose.
  • The Secretary has discretion to define a key calculation term, and the bill does not set out limits or a review process for that choice.
  • The 50% requirement may be hard to assess in practice because the bill does not explain who must meet it or how compliance would be enforced.
  • The bill could increase federal spending, but the supplied material gives no estimate of the size or distribution of that cost.