Lawmakers introduced a bill this week to address growing concerns within Medicare Advantage. It aims to strengthen oversight and patient protections, responding to delays from prior authorization, inconsistent coverage decisions and administrative barriers.

The Medicare Advantage Improvement Act of 2026 includes provisions to prevent delays and denials of care, increase transparency in prior authorization, penalize noncompliant plans and reduce administrative burdens through automated systems. It also would promote prompt payments, block retroactive “clawbacks” and expand access to post-acute care.

“For too long, cases of abuse have crept into Medicare Advantage, pulling it away from its core mission of serving America’s seniors,” said Miller-Meeks (R-Iowa) in a press release issued Wednesday. “As a physician, I’ve seen how these practices delay care, create unnecessary barriers, and increase the cost of health care. This bill restores accountability, cracks down on bad actors, and ensures Iowa seniors can access the care they need, without delay, without denial, and without interference from bureaucratic red tape.”

Lawmakers co-leading the bipartisan bill – all physicians – are U.S. Reps. John Joyce (R-Pa.); Greg Murphy (R-N.C.); Jimmy Panetta (D-Calif.); Ami Bera (D-Calif.); Beth Van Duyne (R-Texas); and Kim Schrier (D-Wash).

“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 that seniors receive timely, high-quality care,” said Joyce.

Unnecessary barriers

Clif Porter, president and CEO of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), urged swift passage of the bill.

“[The bill] represents a significant step towards ensuring Medicare Advantage delivers on its promise to America’s seniors,” Porter said in a press release. “We commend these lawmakers for developing a better way to enable seniors to have timely access to care and hold plans accountable.”

Insurer-led Medicare Advantage plans delay or deny necessary care, particularly post-acute services, the AHCA/NCAL press release noted, citing data from 2019 to 2022 that showed top insurers denied such requests more often than other services, contributing to more older adults leaving Medicare Advantage in their final year of life.

Nisha Hammel, vice president of reimbursement policy and population health at AHCA/NCAL said the bill is correct to target barriers to necessary care.

“This bill addresses many of the obstacles driven by insurer-led Medicare Advantage plans that were making it unnecessarily difficult for seniors and their families to navigate care options and receive coverage for medically necessary care,” said Hammel, “Coverage decisions for Medicare Advantage beneficiaries must be driven by each patient’s needs and clinical necessity, with appropriate oversight that ensures compliance and patient protections.”