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Medicare Advantage Improvement Act of 2026
Starting in 2028, this bill speeds up how quickly Medicare Advantage plans must approve patient care, requiring decisions within 72 hours for standard requests, 24 hours for urgent care, and instant electronic approvals for routine services. Insurance plans would be barred from setting medical coverage rules stricter than traditional Medicare, and they could no longer retroactively cancel payment for care they already approved. Insurers would also be required to pay healthcare providers promptly for approved services and would face federal payment cuts and lower quality ratings if they fail to comply.
People affected—The text does not provide a specific population count, though its mandates apply across all Medicare Advantage organizations, contracted providers, and enrollees nationwide.
Fiscal magnitude—no CBO estimate published
Reach76provisional · pending reviewrigor: heuristic llm
What this bill touches.
Market protections+60Government role in coverage+52
Who it helps · who it burdens.
Who it helps
- Medicare Advantage enrolleesReceive faster prior authorization and appeal decisions, real-time approvals for routine care, protection from coverage criteria more restrictive than traditional Medicare, and expanded access to long-term care hospitals and rehabilitation facilities.
- Healthcare providers and suppliersGain prompt-payment protections for in-network and pre-authorized claims, receive automated or faster prior authorization decisions, can make clinically necessary care adjustments without new authorization requests, and are protected against retroactive coverage denials and downcoding.
- Long-term care hospitals and inpatient rehabilitation facilitiesMedicare Advantage plans must establish adequate network access to their facilities and cannot apply medical necessity or coverage criteria that are more restrictive than traditional Medicare guidelines.
Who it burdens
- Medicare Advantage organizationsMust adhere to strict prior authorization deadlines (72 hours standard, 24 hours expedited), implement real-time automated authorizations through electronic health records, follow traditional Medicare coverage standards and the two-midnight rule, comply with prompt-payment rules for in-network and pre-authorized claims, and face 1.0% to 2.0% payment cuts for poor compliance scores.
- Third-party medical necessity and claims review entitiesBars compensation arrangements based on denial volumes, prohibits using routine automated algorithms to downcode claims post-care, and restricts reviewing pre-authorized services.
- Department of Health and Human ServicesRequired to establish an annual list of routine services eligible for real-time authorization, create a compliance scoring and penalty system, integrate a compliance domain into the 5-star rating system, and collect and publicly report plan-level authorization data.