House Ways & Means Passes ‘Apples’ MA Bill

The House Ways and Means Committee has passed H.R. 4093 out of committee. Called the “Apples to Apples Comparison Act” offered by Rep. Bean (R-Fla.), it attempts to level the playing field when comparing Medicare Advantage (MA) plans to Traditional Medicare.

Over 35 million seniors and individuals with disabilities—representing more than 55 percent of all eligible Medicare beneficiaries—are currently enrolled in MA at an annual cost of $494 billion.

Bean said this high enrollment growth is in part due to MA plans offering a $9,350 out-of-pocket maximum and including supplemental benefits such as prescription drug coverage, hearing, dental, and vision benefits, and $0 premiums.

“Because MA plan designs are materially different from Traditional Medicare, it is difficult to analyze the true benefit and cost tradeoff between the programs,” he said.

For example: MA enrollees are required to enroll in both Medicare Parts A and B, whereas if the same were true for TM, its patient costs would be 9.8 percent higher.

Prominent analysis of MA spending includes contested “favorable selection” bias – an assumption that disproportionately healthier beneficiaries enroll in MA. However, this questionable analysis is a snapshot derived from a small sample of beneficiaries over one year. Bean said:

- Relying on incomplete and unstandardized data distorts Medicare payment policy, misleading congressional oversight and putting coverage stability and extra benefits at risk for over 35 million enrolled seniors.

- When considering Medicare policy changes, Congress must be informed by accurate comparisons of how the programs operate to ensure any reforms will result in seniors receiving improved care and not unjustified cuts in benefits.

Apples to Apples Comparison

Requires CMS to publish detailed risk scores and clinical utilization data between MA and TM enrollees in downloadable, machine-readable formats for each calendar year, allowing a true and accurate comparison of the two programs.

The bill directs MedPAC to conduct a tri-annual retrospective analysis comparing average federal expenditures for MA enrollees against comparable individuals enrolled in traditional FFS, fully adjusting for benefit design, demographics, and patient risk scores.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.