To amend title XVIII to reform the Medicare Advantage program.

This bill significantly reforms the Medicare Advantage (MA) program, primarily effective January 1, 2028, by mandating that MA plans pay for benefits on a capitated basis , with limited exceptions for existing enrollees and specialized plans. It introduces substantial changes to MA plan payments, including a reduction in the blended benchmark amount to 75% and modifications to risk adjustment. Specifically, risk adjustment for health status will rely solely on diagnoses from face-to-face or telehealth visits, excluding chart reviews, and will use a two-year look-back period. The legislation also eliminates quality-based increases to the applicable percentage for MA plans and allows the Secretary to establish budget-neutral stop-loss payments for plans experiencing unexpectedly high expenditures. Furthermore, it institutes automatic enrollment for eligible beneficiaries into the lowest-premium MA plan available, though individuals retain the option to decline this enrollment. A significant change is the introduction of a mandatory three-year continuous enrollment period , preventing beneficiaries from switching plans or returning to traditional Medicare during this time, except in cases of hardship. Finally, the bill requires MA plans to include hospice care and creates a new Stark Law exception for designated health services like durable medical equipment or Part D drugs furnished under an MA plan.