Sponsors (9)
This bill strengthens directory transparency and limits surprise out-of-network cost-sharing for Medicare beneficiaries who rely on plan directories, at the cost of added administrative burden for plans/providers and potential network reductions, scope limits on protections, and provider privacy/reputation risks.
Medicare beneficiaries will face fewer unexpected out-of-network bills because cost-sharing must be treated as in‑network (or the lesser amount) when they relied on a directory-listed provider who turns out to be out‑of‑network.
Medicare beneficiaries, including patients with chronic conditions, will have better access to up-to-date online provider directories, making it easier to find available clinicians and services.
Hospitals, health systems, providers and plans will face clearer standards and public accuracy scores for directories, creating stronger accountability and incentives to keep listings current.
Medicare Advantage organizations, hospitals, and providers will incur additional administrative costs to verify, update, and report directory data, which could raise plan operating costs and indirectly put upward pressure on premiums or reduce plan offerings.
Medicare beneficiaries (including patients with chronic conditions) could see reduced network options if plans rapidly remove providers (e.g., within 5 business days) after determining nonparticipation, particularly if removals are applied overbroadly or without timely reconciliation.
Some beneficiaries will be ineligible for cost-sharing protection because the safeguard applies only when the enrollee relied on the plan directory at the appointment date, limiting relief for those who used other information sources or discovered errors after scheduling.
Based on analysis of 2 sections of legislative text.
Requires specified Medicare Advantage plans to keep accurate online provider directories with frequent verification, remove nonparticipating providers quickly, and limit enrollee cost-sharing when listed providers are out-of-network, starting plan year 2028.
Introduced September 10, 2025 by James Varni Panetta · Last progress September 10, 2025
Requires Medicare Advantage organizations offering network-based plans and certain private fee-for-service MA plans to publish and keep an accurate, publicly available online provider directory, verify provider information at least every 90 days (facilities at a Secretary-set but at least annual frequency), flag unverifiable entries, and remove providers within 5 business days after determining they no longer participate. For plan years beginning in 2028 and later, it also limits enrollee cost-sharing when an enrollee receives services from a nonparticipating provider who was listed in the plan’s directory on the appointment date.