House Committee Advances Medicare Advantage “Apples to Apples” Bill

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The House Ways and Means Committee on September 16, 2026, advanced HR 4093, the Apples to Apples Comparison Act, legislation that would change how the Medicare Payment Advisory Commission (MedPAC) compares spending in Medicare Advantage (MA) with traditional Medicare.

At the center of the debate is how those comparisons account for "favorable selection"-differences in expected health care spending between beneficiaries enrolled in MA and those in traditional Medicare as a result of MA plans attracting healthier seniors. MedPAC incorporates favorable selection when estimating MA spending relative to traditional Medicare and currently estimates that Medicare will spend substantially more on MA beneficiaries in 2026 than it would have spent if those beneficiaries were enrolled in traditional Medicare.

The committee-approved bill would require MedPAC to produce two analyses: one that accounts for favorable selection and another that does not. Because favorable selection represents a significant share of MedPAC's estimated MA spending differential, excluding it would produce a substantially lower estimate of overpayments to MA plans and a more insurer-friendly picture of the program's costs. MedPAC's 2026 estimate showed that Medicare is paying 14% more per Medicare Advantage enrollee than it would if those same individuals were enrolled in traditional Medicare. These excess payments amount to $76 billion in additional spending, with favorable selection accounting for $57 billion of that total.

For LeadingAge, that raises questions about whether the proposal would advance meaningful transparency. LeadingAge has consistently supported better MA data and greater transparency, but additional data are only useful if the methodology provides policymakers with an accurate picture of program costs, beneficiary access, and provider payment. Creating competing estimates that intentionally exclude a factor MedPAC considers relevant could make it harder for lawmakers and their staff to evaluate the costs of health policy reforms.

The issue also has broader implications for congressional health policy. MA payment reforms have increasingly been discussed as a potential source of federal savings that could help finance other health care priorities. While MedPAC estimates do not determine how the Congressional Budget Office would score a specific legislative proposal, a lower estimate of excess MA spending could affect how much savings Congress perceives as available-and potentially reduce lawmakers' willingness to use MA reforms to finance other investments in the health care system.

The bill also includes provisions that could improve transparency, including more detailed Centers for Medicare and Medicaid Services (CMS) reporting on Medicare enrollment and expenditures and additional MedPAC analysis of differences in value, benefits, outcomes, and data gaps between MA and traditional Medicare.

The legislation would not directly change MA payment rates or provider reimbursement. LeadingAge will continue reviewing the proposal and advocating for MA transparency efforts that give policymakers complete and meaningful information about program costs, access, payment, and value.