Medicare Advantage Improvement Act of 2026

This bill changes rules for Medicare Advantage plans starting in 2028. Plans would have to answer standard prior authorization requests within 72 hours and urgent ones within 24 hours, give real-time automated decisions for certain listed services, and report more authorization data to the public. Plans could not deny coverage on medical necessity grounds after approving care except for good cause or fraud, could not use stricter medical necessity rules than traditional Medicare, and would face limits on using outside review companies. The federal health department would score each plan company on rule compliance and cut its payments by 1 to 2 percent if it scores below 90, and would add a compliance category to plan star ratings. Plans would also have to pay approved claims promptly and automatically and provide adequate access to long-term care hospitals and rehabilitation facilities.

Full text and official record on Congress.gov

Sponsors

• John Joyce Republican sponsor
• 24 cosponsors