Bill would force faster care approvals from Medicare Advantage plans

What does this do?

This bill sets deadlines for Medicare Advantage plans to approve medical care requests—72 hours for routine cases, 24 hours for urgent ones—starting in 2028, with instant automated approval for certain low-risk services. It also bars plans from denying payment or downgrading billing codes after care has already been authorized and delivered, except in fraud cases, and requires them to use the same medical necessity standards as traditional Medicare.

Who does it affect?

This affects the roughly 30+ million Americans enrolled in Medicare Advantage plans, the doctors and hospitals who treat them, and the insurance companies that run these plans.

Why does it matter?

The changes would restrict insurers' current flexibility to review, deny, or reduce payment for care after it's provided, and require public posting of coverage rules and third-party reviewer practices.

What does it cost, and who pays?

• New compliance scoring system
• Poor scores cut Medicare payments
• Scores affect public star ratings