S. 3848 — Apples to Apples Comparison Act of 2026

This section amends Medicare administrative reporting requirements under SSA sec. 1874(g) to require the Centers for Medicare & Medicaid Services (CMS), beginning in 2027, to publish its annual report information on its public website in machine-readable format, including breakdowns by state, county, and Metropolitan Statistical Area (MSA), and by each category of individuals specified in new subsection (h)(1); and establishes a special rule for the 2027 report requiring inclusion of enrollment data submitted since 2015, broken out by county, MSA, and those categories. It further adds new subsection (h) requiring CMS, not later than 30 days after the end of each year (beginning with 2027), to publish on its public website in machine-readable format, for each county and MSA, the total and average expenditures under Medicare title XVIII for items and services furnished to beneficiaries residing therein—for each month in the specified historical and projected periods—broken down by beneficiary category based on enrollment status under Parts A, B, C (including specialized Medicare Advantage plans for special needs individuals, other Medicare Advantage plans, and employer group waiver plans), and D, and participation in Federal health care programs (as defined in SSA sec. 1128B(f)), Federal Employees Health Benefits plans, group health plans, or Medicare supplemental policies. (Thus, the changes promote granular public transparency into Medicare spending patterns by geography and beneficiary characteristics.)

This section directs the Medicare Payment Advisory Commission (MedPAC) to include in its annual reports to Congress, beginning in 2027, a retrospective analysis comparing average Medicare expenditures for individuals enrolled in Medicare Advantage plans under part C to average expenditures for fee-for-service beneficiaries under parts A and B who are eligible for but not enrolled in such plans. For the analysis, MedPAC must (1) use data from the CMS Chief Actuary, Medicare trust fund Boards of Trustees, and other sources it deems appropriate; (2) account for differences in Medicare Advantage value (e.g., out-of-pocket caps, supplemental benefits, and part D drug integration), demographics, and HCC risk scores, but not favorable selection in enrollment; and (3) publicly release the data (in replicable, de-identified form), methodology (at least 60 days before submission, with 30 days for comment), and responses to comments.

This section requires the Boards of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplementary Medical Insurance Trust Fund to include, as part of their annual reports beginning in 2027, aggregate and average Medicare expenditures for (1) individuals entitled to Part A benefits only (not enrolled in Part B), (2) individuals enrolled in Part B only (not entitled to Part A), and (3) individuals entitled to Part A, enrolled in Part B, and not enrolled in Medicare Advantage under Part C (broken down by Part A and Part B expenditures). It further directs the Boards to disaggregate, to the extent practicable, all public expenditure data (including data tables) by these categories.