What does Preamble of HR 4093 do?

This bill, formally titled 'To amend title XVIII of the Social Security Act to require the Secretary of Health and Human Services to publish information on expenditures under the Medicare program, and for other purposes,' aims to modify the Social Security Act. The bill requires the Secretary of Health and Human Services to publish information regarding expenditures within the Medicare program. The bill was introduced by Mr. Bean of Florida and Mr. Hern of Oklahoma.

What does SHORT TITLE. of HR 4093 do?

This bill is formally titled the Apples to Apples Comparison Act of 2025.

What does REQUIRING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO PUBLISH of HR 4093 do?

This section amends Section 1874 of the Social Security Act to require the Secretary of Health and Human Services to publish information on Medicare expenditures. Beginning in 2025, reports will include data broken down by county and Metropolitan Statistical Area. The reports will detail total and average expenditures for items and services furnished to Medicare beneficiaries, categorized by enrollment status in various programs (Parts A, B, D, Medicare Advantage, and other health care programs). The Secretary must publish this information in machine-readable files on the Centers for Medicare & Medicaid Services website. For the 2025 report, enrollment information from previous years (2015 onward) will also be included. The 'specified historical period' is defined as the 10-year period ending on the last day of a year, and the 'specified projected period' is a duration (not exceeding 5 years) beginning on the first day of the subsequent year, as determined by the Secretary.

What does MEDPAC ANALYSIS OF MEDICARE ADVANTAGE AND FEE-FOR-SERVICE of HR 4093 do?

This section amends Section 1805(b) of the Social Security Act. The Commission (MEDPAC) must include a retrospective analysis of Medicare Advantage (MA) and fee-for-service (FFS) expenditures in its annual reports starting in 2026. The analysis will compare average expenditures for individuals in MA plans to those in FFS. The Commission must use data from the Chief Actuary of CMS and the Boards of Trustees of the Federal Hospital and Supplementary Medical Insurance Trust Funds. The analysis must consider differences in value between MA and FFS, including out-of-pocket caps, supplemental benefits, and drug integration. Demographic differences between MA and FFS enrollees must also be taken into account. HCC risk scores should be considered, but favorable selection differences related to plan enrollment should not. The Commission must make the data used in the analysis publicly available, allowing for replication while protecting personal information. The methodology for the analysis must be made public for comment at least 30 days prior to submission, and the Commission must respond to comments publicly.

What does TRUSTEES REPORT OF EXPENDITURE INFORMATION. of HR 4093 do?

This section amends Section 1874 of the Social Security Act. The Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund are required to jointly include expenditure information in their reports. Starting in 2026, these reports must include aggregate and average expenditures for specific categories of individuals. The categories include individuals entitled to part A benefits but not enrolled in part B, individuals enrolled in part B but not entitled to part A benefits, and individuals entitled to both part A and part B benefits but not enrolled in a Medicare Advantage plan. The Boards must also disaggregate expenditure data to the extent practicable based on these categories.

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Apples to Apples Comparison Act of 2025 — HR. 4093

Last updated: 6/24/2025 · Introduced: 6/24/2025

Author: Aaron Bean (R-FL)

TL;DR (AI)

The bill requires the Secretary of Health and Human Services to publish detailed Medicare expenditure data, broken down by county and Metropolitan Statistical Area, starting in 2025.
Beginning in 2026, the Medicare Payment Advisory Commission (MEDPAC) must analyze and compare Medicare Advantage (MA) and fee-for-service (FFS) expenditures, considering factors like value and demographic differences.
The Boards of Trustees of the Federal Hospital and Supplementary Medical Insurance Trust Funds must include expenditure information, categorized by enrollment status, in their annual reports starting in 2026.

119th Congressin committeeOfficial page

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Includes provisions on preamble, short title., and 3 more.

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