H.R. 6031 – Medicare Advantage Integrity Act of 2025

AI-Generated Summary

Updated November 23, 2025 at 7:52 PM UTC

The Medicare Advantage Integrity Act of 2025 changes how Medicare Advantage benchmark payments are calculated. It creates a minimum level for the geographic adjustment used in setting those payments in areas where few people are enrolled in traditional Medicare fee‑for‑service. The bill also directs that at least half of any extra money from this adjustment be used for basic benefits. It affects Medicare Advantage plans, the providers that serve their members, and the patients who receive care.

Key Provisions

Sets a floor of 0.70 for the average geographic adjustment when calculating Medicare Advantage benchmark rates for 2026 and later, ensuring low‑penetration regions receive a minimum payment level.
Requires that at least 50% of any increase in the blended benchmark amount resulting from the new geographic adjustment be spent on basic benefits for plan members.

Legislative Activity

Stay on top of the latest movement without scrolling through every action

1 earlier action

HouseIntro Referral Latest Action

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Ways and Means Committee

November 12, 2025

View full timeline

HouseIntro Referral

Introduced in House

November 12, 2025

HouseIntro Referral

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Ways and Means Committee

November 12, 2025

Bill Text

Latest available legislative text

Reading Mode

Raw Text PDF XML

Introduced in HouseIssued November 12, 2025

I

119th CONGRESS

1st Session

H. R. 6031

IN THE HOUSE OF REPRESENTATIVES

November 12, 2025

Mr. Hernández (for himself, Ms. Salazar, and Mr. Soto) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to establish a floor in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration.

1.

Short title

This Act may be cited as the Medicare Advantage Integrity Act of 2025.

2.

Addressing disparities in Medicare Advantage benchmark levels based on penetration

(a)

In general

Section 1853(n) of the Social Security Act (42 U.S.C. 1395w–23(n)) is amended—

(1)

in paragraph (1)(B), by striking subsequent year and inserting subsequent year, subject to paragraph (6),; and

(2)

by adding at the end the following new paragraph:

(6)

Average geographic adjustment floor

For 2026 and subsequent years, when calculating the adjusted average per capita cost under section 1876(a)(4) for the purposes of establishing the base payment amount specified in paragraph (2)(E), the average geographic adjustment shall not be less than 0.70 for any area. For the purposes of the previous sentence, the Secretary may define the term average geographic adjustment under subparagraph (A) by program instruction or otherwise.

.

(b)

Ensuring plan payments flow to providers and patients

Section 1854(a)(6) of the Social Security Act (42 U.S.C. 1395w–24(a)(6)) is amended by adding at the end the following new subparagraph:

(C)

Ensuring increased payments support care

With respect to the increase in blended benchmark amount attributable to the application of section 1853(n)(6), no less than 50 percent shall be directed toward payment for basic benefits as defined in section 1852(a)(1)(B).

.