The "Apples to Apples Comparison Act of 2026" aims to significantly enhance the transparency and comparability of Medicare expenditure data. It mandates that, beginning in 2027, the Secretary of Health and Human Services publish detailed information on Medicare expenditures on the Centers for Medicare & Medicaid Services (CMS) public website. This data must be provided in machine-readable files, broken down by county and Metropolitan Statistical Area, and categorized by various types of beneficiaries, including those with different Medicare parts and supplemental coverages.

Furthermore, the bill requires the Medicare Payment Advisory Commission (MEDPAC) to conduct and include a retrospective analysis in its annual reports, starting in 2027. This analysis will compare average expenditures for individuals enrolled in Medicare Advantage plans against those in traditional Fee-for-Service Medicare who are eligible for MA but not enrolled. MEDPAC's analysis must consider factors like supplemental benefits and demographic differences, but specifically exclude favorable selection differences, and all data and methodologies must be made public for comment.

Finally, the legislation directs the Boards of Trustees of the Federal Hospital Insurance Trust Fund and Federal Supplementary Medical Insurance Trust Fund to incorporate disaggregated expenditure information into their annual reports, also beginning in 2027. This includes aggregate and average expenditures for specific categories of beneficiaries, such as those with Part A only, Part B only, or Part A and B not enrolled in a Medicare Advantage plan. The goal is to provide a clearer, more granular understanding of Medicare spending across different beneficiary groups and plan types.