Medicare Advantage Improvement Act of 2026

This bill changes rules for Medicare Advantage plans, mostly starting in 2028. Plans would have to answer standard prior authorization requests within 72 hours and urgent ones within 24 hours, give instant automated decisions for certain listed services sent through electronic health records, and stop requiring new approval when a doctor makes a clinically needed change to an approved service. Plans could not use stricter medical necessity rules than traditional Medicare, could not later deny payment for approved services except for good cause or fraud, and would have to pay approved claims promptly. The federal health department would score each plan company on rule compliance, publish the scores, and cut payments by 1 to 2 percent for companies with lower scores.

Full text and official record on Congress.gov

Sponsors

• Roger Marshall Republican sponsor
• 3 cosponsors