H.R. 4093: Apples to Apples Comparison Act of 2025
Sponsor
Aaron Bean
Republican · FL-4
Bill Progress
Latest Action · Jun 24, 2025
Referred to 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. for review
See what Medicare spends in your county
Why it matters
Medicare's spending data lands in annual reports that aren't built for side-by-side comparison. H.R. 4093 would require the Centers for Medicare & Medicaid Services to publish total and average Medicare spending for every county and metro area — in downloadable, machine-readable files — within 30 days of each year's end, with 10 years of history behind it. It would also order MedPAC to compare what Medicare pays for private Medicare Advantage plans against traditional Medicare, starting in 2026.
H.R. 4093 — the Apples to Apples Comparison Act — would require the Centers for Medicare & Medicaid Services to publish detailed Medicare spending data online, in downloadable files, within 30 days after each year ends.
The data would be broken down by county and metro area and sorted into 35 categories of beneficiaries — people in traditional Medicare, people in Medicare Advantage, those with and without drug coverage, those with supplemental insurance, and more. Each release would carry 10 years of history and up to 5 years of projections.
Starting in 2026, the bill would also order MedPAC — the independent agency that advises Congress on Medicare payments — to publish a yearly comparison of what Medicare spends on Medicare Advantage enrollees versus comparable people in traditional Medicare. The analysis would have to account for differences in benefits, demographics, and patient risk scores.
The bill draws one specific line: MedPAC must account for patient risk scores but may not adjust for "favorable selection" — the pattern of healthier, lower-cost people enrolling in Medicare Advantage. MedPAC would also have to make its data and methodology public, take 30 days of comment, and respond before publishing.
Finally, the annual Medicare Trustees reports would have to break out spending separately for people with Part A only, Part B only, and those with both who aren't in Medicare Advantage. None of this creates a new program or new spending — it's a transparency and reporting mandate built on data the government already collects.
H.R. 4093 Bill Summary
What H.R. 4093 actually does.
County-level Medicare spending, published every year
Within 30 days of each year-end, CMS would post total and average Medicare spending for every county and metro area in downloadable, machine-readable files.
A decade of history, sorted 35 ways
Each release would include 10 years of historical data and up to 5 years of projections, broken into 35 categories of beneficiaries — from traditional Medicare to Medicare Advantage, with and without drug or supplemental coverage.
A yearly Medicare Advantage vs. traditional comparison
Starting in 2026, MedPAC would publish a retrospective analysis comparing average spending on Medicare Advantage enrollees with comparable people in traditional Medicare, accounting for benefits, demographics, and risk scores.
No adjustment for "favorable selection"
The bill instructs MedPAC to factor in patient risk scores but bars it from adjusting for favorable selection — the tendency of healthier people to choose Medicare Advantage. The agency must publish its methodology, take 30 days of comment, and respond before each analysis.
Trustees reports get a finer breakdown
Beginning in 2026, the annual Medicare Trustees reports would separate spending for people with Part A only, Part B only, and those with both who aren't in a Medicare Advantage plan.
Who benefits from H.R. 4093?
Health researchers and journalists
Machine-readable, county-level data with 10 years of history would let anyone analyze Medicare spending patterns without filing records requests or waiting on custom reports.
Taxpayers footing the Medicare bill
A standardized Medicare Advantage vs. traditional comparison would put hard numbers on one of the biggest cost debates in federal health policy.
Local communities and regional health planners
County and metro breakdowns would show where Medicare dollars flow and how spending varies from one region to the next.
Policymakers debating Medicare Advantage payments
A consistent, public methodology would give Congress a common set of figures to argue over, instead of competing estimates.
Who is affected by H.R. 4093?
Centers for Medicare & Medicaid Services
Takes on a new annual publishing duty: posting total and average Medicare spending for every county and metro area, across 35 beneficiary categories, in machine-readable files within 30 days of year-end.
MedPAC
Must produce and publish a new yearly comparison of Medicare Advantage and traditional Medicare spending starting in 2026, open its methodology to public comment, and respond to every comment.
Medicare Advantage plans
Their spending would be measured directly against traditional Medicare in a recurring federal analysis — one the bill specifies must leave out favorable-selection adjustments.
The Medicare Trustees
Their annual reports would have to disaggregate expenditures by beneficiary category, including a Part A versus Part B split for people in traditional Medicare.
HR4093 Legislative Journey
House: Committee Action
Jun 24, 2025
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.
About the Sponsor
Aaron Bean
Republican, Florida's 4th congressional district · 3 years in Congress
Committees: Ways and Means
View full profile →
Cosponsors (16)
All 16 cosponsors are Republicans. Cosponsors represent 11 states: Florida, Indiana, Minnesota, and 8 more.
Kevin Hern
Republican · OK
Rudy Yakym
Republican · IN
Carol Miller
Republican · WV
Beth Van Duyne
Republican · TX
Claudia Tenney
Republican · NY
Gregory Steube
Republican · FL
Michelle Fischbach
Republican · MN
Mike Carey
Republican · OH
Jefferson Shreve
Republican · IN
Kat Cammack
Republican · FL
Nicholas Langworthy
Republican · NY
Blake Moore
Republican · UT
Committee Sponsors
Energy and Commerce Committee
4 of 54 committee members cosponsored
Ways and Means Committee
11 of 45 committee members cosponsored
41 Republicans across these committees haven't cosponsored yet. Mobilize their constituents
What laws does H.R. 4093 change?
1 changes
Sections Amended
Section 1805(b) of Social Security Act (42 U.S.C. 1395b-6(b))
adding at the end the following new paragraph: ``(12) Analysis of medicare advantage and fee-for-service expenditures
H.R. 4093 Quick Facts
- Committee
- Energy and Commerce
- Chamber
- House
- Policy
- Health
- Introduced
- Jun 24, 2025
Referred to 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. for review
Jun 24, 2025
Official Sources
Official bill page with full text, actions timeline, cosponsors, and status for the Apples to Apples Comparison Act of 2025.
Existing CMS dataset providing Medicare spending variation by county and state — the type of data HR 4093 would mandate be published annually in machine-readable format.
County-level FFS reimbursement and enrollment data for Medicare Parts A and B, the baseline comparison dataset for Medicare Advantage versus traditional Medicare analysis.
MedPAC is the independent congressional agency that HR 4093 Section 3 tasks with producing the annual comparative analysis of Medicare Advantage vs. fee-for-service spending.
Annual Trustees reports on the Hospital Insurance Trust Fund. HR 4093 Section 4 requires these reports to disaggregate expenditures by Part A only, Part B only, and Parts A+B beneficiaries not in Medicare Advantage.
CMS overview of the Medicare Advantage program, the private-plan alternative to traditional Medicare that HR 4093 subjects to county-level spending comparison.
Primary committee of referral for HR 4093, with jurisdiction over Medicare payment policy and the Hospital Insurance Trust Fund.
Second committee of referral for HR 4093, with jurisdiction over public health programs and CMS oversight.
H.R. 4093 Common Questions
When would CMS have to publish Medicare spending data under H.R. 4093?
CMS would have to post each year's data within 30 days after the year ends, starting with 2025.
How detailed would the Medicare spending data be?
Quite detailed. The numbers would be broken out by county and metro area and split into 35 categories of beneficiaries — traditional Medicare, Medicare Advantage, people with or without drug or supplemental coverage — and posted as downloadable, machine-readable files.
How many years of Medicare data would H.R. 4093 require?
Each yearly release would include 10 years of historical spending and, at the agency's option, up to 5 years of projections.
Would Medicare Advantage be compared to traditional Medicare?
Yes. Starting with its 2026 report, MedPAC would publish a yearly comparison of average spending on Medicare Advantage enrollees versus comparable people in traditional Medicare, accounting for differences in benefits, demographics, and patient risk scores.
What is "favorable selection," and how does the bill treat it?
Favorable selection is the pattern of healthier, lower-cost people enrolling in Medicare Advantage, which can make the plans look cheaper than they are. H.R. 4093 tells MedPAC to adjust for patient risk scores but specifically bars it from adjusting for favorable selection.
Could the public see and weigh in on MedPAC's methodology?
Yes. MedPAC would have to release the data behind its analysis so others can replicate it, publish its methodology at least 60 days ahead, take 30 days of public comment, and respond to the comments before finalizing.
What would change in the Medicare Trustees reports?
Starting in 2026, the annual Medicare Trustees reports would break out spending for people with Part A only, Part B only, and those with both who aren't in a Medicare Advantage plan — with that last group split between Part A and Part B costs.
Does H.R. 4093 cost anything or create a new program?
No. The bill doesn't create a new program or authorize new spending. It's a reporting and transparency mandate built on data CMS, MedPAC, and the Trustees already collect. No CBO cost estimate has been published.
Based on H.R. 4093 bill text
H.R. 4093 Bill Text
“To amend title XVIII of the Social Security Act to require the Secretary of Health and Human Services to publish information on expenditures under the Medicare program, and for other purposes.”
Source: U.S. Government Publishing Office
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