Medicare Advantage Could Change for Millions Under New Bill

Medicare Advantage could face some of its most significant reforms in years under a new bill introduced in the U.S. House.

The legislation, known as the Medicare Advantage Improvement Act of 2026, was introduced by a group of Democratic and Republican lawmakers, many of whom are physicians. If passed, the law would increase oversight of private plans and curb practices lawmakers say delay or even deny care for seniors.

Why It Matters  

Supporters say the bill is designed to address longstanding complaints about prior authorization delays and coverage denials affecting Medicare Advantage enrollees. 

More than half of the people eligible for Medicare are now enrolled in Medicare Advantage plans, which are run by private insurers under contract with the federal government. As enrollment has grown, the program has faced increased scrutiny from providers and lawmakers over how plans manage care.

Photo illustration of a Medicare card and a $100 bill clipped to a medical report. | Bill Oxford/Getty Images

What To Know

The Medicare Advantage Improvement Act of 2026 would make several changes intended to align Medicare Advantage more closely with traditional Medicare. 

For one, Medicare Advantage plans would be prohibited from using coverage criteria more restrictive than those of traditional Medicare. There would also be set deadlines for prior authorization decisions, requiring plans to respond to standard requests within 72 hours and expedited requests within 24 hours.

“Medicare is a promise to America’s seniors that they will have dependable access to quality healthcare in their later years. However, that promise has been undermined by unnecessary barriers to care – particularly through excessive use of prior authorization and inappropriate coverage denials in Medicare Advantage,” Representative John Joyce, who in part introduced the bill, said in a statement. “The Medicare Advantage Improvement Act will restore accountability, reduce unnecessary barriers and ensure that seniors receive timely, high-quality care.”

Under the law more generally, the use of prior authorization would be limited and ultimately banned when a service has already been approved or when clinicians make medically necessary changes.

Plans would also be barred from denying payment after care has already been authorized, and a compliance scoring system would be created with potential payment cuts for consistently low‑performing plans.

“This isn't about taking away benefits,” Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek.

“It's about forcing insurers to stop weaponizing prior authorization as a gatekeeping tool. Medicare Advantage covers 35 million seniors now, and insurers systematically delay or deny post-acute care requests at rates far exceeding approvals for other services. The bill directly targets that practice.”

The bill would also expand access to post‑acute care providers, a sector that has increasingly raised concerns about delayed approvals under Medicare Advantage. 

Provider groups, particularly those representing long‑term care and home health organizations, have broadly welcomed the proposal and urged Congress to move quickly, calling it one of the most sweeping Medicare Advantage reform efforts to date. 

“We commend these lawmakers for developing a better way to enable seniors to have timely access to care and hold plans accountable,” Clif Porter, president and CEO of the American Health Care Association / National Center for Assisted Living, said in a statement. “We urge continued bipartisan support and swift passage through Congress.” 

At the same time, the bill would likely face pushback from insurers, who have argued that prior authorization and care management tools help control costs and improve care coordination. The legislation does not eliminate prior authorization outright but seeks to limit its use and standardize the time frames within which plans must act.

“A lot of this tends to be more symbolic than substantive. It sounds good on paper but often lacks real enforcement or meaningful change,” Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek. “Could parts of it pass? Possibly. But if it does, expect it to be watered down, with limited impact where it matters most.”

What Happens Next

The bill was introduced this month and has been referred to committee. Its effective date, if enacted, would not be immediate, and lawmakers have not set a timeline for a House vote.

 

By Suzanne Blake