Medicare Advantage Could Change for Millions Under New Bill
Summary
A new bill called the Medicare Advantage Improvement Act of 2026 has been introduced in the U.S. House to change how Medicare Advantage plans work. The bill aims to limit delays and denials of care by private insurers and make these plans follow rules more like traditional Medicare.Key Facts
- The bill was introduced by both Democratic and Republican lawmakers, many of whom are doctors.
- Medicare Advantage plans are run by private companies but serve more than half of Medicare-eligible seniors.
- The bill would stop Medicare Advantage plans from having stricter coverage rules than traditional Medicare.
- Plans must respond to regular care approval requests within 72 hours and urgent ones within 24 hours.
- Prior authorization (approval before care) would be limited and banned in certain cases, like when services were already approved.
- Plans could not deny payment after authorizing care.
- A system to score plan compliance would be created, and poorly performing plans might lose payments.
- The bill is supported by provider groups but may face opposition from insurance companies, who say prior authorization helps control costs.
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