United States 119th Congress Status: In Committee Bipartisan · 1 D · 1 R cosponsors

HR 5243 — To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage.

Last action — Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote.

  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill is in committee in the House. Introduced September 10, 2025. It must pass committee before a floor vote.

Next likely step: a committee vote, then a floor vote in the House.

Odds of enactment

Low chance

Based on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.

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A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Advancing 34% · moderate confidence

  • In Committee

    Current position in the legislative process.

  • 2 sponsors

    1 primary, 1 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (1 D · 1 R) — cross-party backing.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

In plain language

This bill amends Medicare Advantage to enhance data transparency for supplemental benefits.

The bill aims to increase transparency regarding data on supplemental benefits provided under Medicare Advantage plans. This could help beneficiaries understand the options available to them.

What this means for you
  • Consumers: This means potentially better access to information about your Medicare Advantage options.

Bill Text

How this bill changes current law

4 changes Share ↗

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill adds requirements for reporting and accessibility of enrollee-level data on supplemental benefits under Medicare Advantage.

  • 42 U.S.C. 1395w-27(e)

    (6) Reporting of enrollee-level data on supplemental benefits.--(A) In general.--Beginning with plan years beginning on or after January 1, 2029, a contract under this section with an MA organization shall require the organization to submit to the Secretary, for each MA plan offered by the organization, enrollee-level data on supplemental benefits (by item or service, or category of item or service, as determined appropriate by the Secretary, and national provider identifier), including eligibility for such benefits, the types of benefit categories offered, data on utilization of and payments for such benefits (including the total amount spent by the plan for each enrollee who utilized such benefits and the total out-of-pocket cost per utilization for each enrollee).

    This amendment requires MA organizations to report detailed enrollee-level data on supplemental benefits starting in 2029.

  • 42 U.S.C. 1395w-27(e)

    (B) Data access.--(i) In general.--On the first Monday in October of each year (beginning with 2030), the Secretary shall make data submitted under subparagraph (A) available to individuals and entities for the purpose of conducting--(I) evaluations and other analysis to support the program under this title; and (II) other health care related research.

    This requires the Secretary to make enrollee-level data available annually starting in 2030 for research and evaluation purposes.

  • 42 U.S.C. 1395w-27(e)

    (ii) Public use data file.--Not later than October 1 of each year (beginning with 2030), the Secretary shall make a public use data file containing the data submitted under subparagraph (A) available on the internet website of the Centers for Medicare & Medicaid Services.

    The Secretary must publish a public data file of the reported enrollee-level data on the CMS website by October 1 each year starting in 2030.

  • 42 U.S.C. 1395w-27(e)

    (iii) Confidentiality.--In making data available under this subparagraph, the Secretary shall have in place procedures to safeguard the privacy of any individually identifiable enrollee information.

    This ensures that the privacy of individually identifiable enrollee information is protected when making data available.

Action History

  1. Introduced in House

  2. Introduced in House

  3. 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.

  4. 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.

  5. Referred to the Subcommittee on Health.

  6. Subcommittee Consideration and Mark-up Session Held

  7. Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote.

Sponsors

Sponsorship breakdown

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1 sponsors · 1 co-sponsors · 545 not signed on

Sponsors (1)

Co-sponsors (1)

Not signed on (545)

545 members have not signed on to this bill.

Show all 545 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

finance healthcare health-insurance technology
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

Who sponsors HR 5243?
HR 5243 is sponsored by McClellan, Jennifer L. (Democratic) and Wittman, Robert J. (Republican).
What is the current status of HR 5243?
This bill is in committee in the House. Introduced September 10, 2025. It must pass committee before a floor vote.
Where can I track HR 5243?
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