Lawmakers Push for Improved Oversight and Access in Medicare Advantage Plans
In a significant move to enhance the Medicare Advantage program, U.S. House lawmakers have put forth a bipartisan bill designed to strengthen oversight and guarantee that seniors receive prompt, high-quality care. Introduced by Pennsylvania Republican John Joyce, MD, the Medicare Advantage Improvement Act of 2026 seeks to tackle existing barriers to coverage and treatment head-on.
Key Provisions of the Medicare Advantage Improvement Act
The proposed legislation, unveiled on April 20, encompasses several critical measures aimed at reforming the Medicare Advantage landscape:
- Strengthening oversight and accountability for plans that fail to meet compliance standards
- Increasing transparency and streamlining prior authorization processes to reduce delays in care
- Aligning coverage criteria with traditional Medicare to ensure consistency
- Reducing administrative burdens with automated, real-time systems
- Expanding access to post-acute care providers
“Medicare is a promise to America’s seniors that they will have reliable access to quality health care in their later years. However, that promise has been undermined by unnecessary barriers to care – particularly the overuse of pre-authorizations and inappropriate denials of coverage in Medicare Advantage,” Joyce stated. “As a physician, I have seen firsthand how these delays harm patients and take valuable time away from the doctor-patient relationship. The Medicare Advantage Improvement Act will restore accountability, reduce unnecessary barriers and ensure seniors receive timely, high-quality care.”
Bipartisan Support and Industry Backing
The bill has garnered bipartisan support with co-sponsorship from Reps. Kim Schrier, D-Wash., Gregory Murphy, R-N.C., Jimmy Panetta, D-Calif., Mariannette Miller-Meeks, R-Iowa, Ami Bera, D-Calif., and Beth Van Duyne, R-Texas.
“Health insurance companies have abused Medicare Advantage plans for too long, and they continue to drive up costs, deny coverage and force taxpayers to pay the price. We need stronger oversight of the Medicare Advantage program so that all seniors receive the care they were promised,” Schrier noted. “I am extremely proud to have worked on these much-needed Medicare Advantage reforms that will hold insurance companies accountable and provide patients with timely, high-quality care.”
The legislation has also received praise from the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL). Clif Porter, president and CEO of AHCA/NCAL, emphasized that the bill “represents a significant step toward ensuring that Medicare Advantage delivers on its promise to America’s seniors.”
Additionally, Nisha Hammel, vice president of reimbursement policy and population health at AHCA/NCAL, highlighted that it “removes many of the barriers created by insurer-led Medicare Advantage plans,” which “unnecessarily complicate” navigating options and obtaining coverage. Hammel stressed the importance of basing coverage decisions on the needs and clinical necessity of each individual patient, with appropriate oversight to ensure compliance and patient protection.
St. Louis-based Ascension has also announced its support for the legislation. Eduardo Cornado, president and CEO of Ascension, stated that “too many patients face unnecessary delays, denials and hurdles that impede timely and necessary care.” Cornado added, “This legislation is an important step toward strengthening the doctor-patient relationship, improving transparency and enabling Medicare Advantage to better serve seniors and the physicians who care for them.”
Looking Ahead: The Future of Medicare Advantage
First introduced in 1997, the Medicare Advantage plan continues to evolve. According to KFF data, by 2025, more than half of eligible Medicare beneficiaries – about 34.1 million people – are projected to be enrolled in these plans. In January, the Centers for Medicare & Medicaid Services (CMS) released proposed rates for the 2027 plan year, keeping reimbursement rates essentially unchanged for the year.
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