Sponsors (9)
The bill strengthens cost protections and transparency for Medicare Advantage enrollees by capping cost sharing and improving provider directories, but it imposes verification and reporting burdens, enforcement risks that could affect plan availability or premiums, and raises privacy/security concerns around publicly released provider data.
Medicare Advantage enrollees will pay lower out‑of‑pocket cost sharing when care is furnished by a nonparticipating provider listed in a plan directory — cost sharing capped at the lesser in‑network amount beginning in 2028.
Medicare Advantage enrollees (including people with chronic conditions) will have better access to up‑to‑date provider information (languages, telehealth availability, accepting new patients), making it easier to find suitable clinicians.
MA plans and providers will incur additional administrative burdens and costs to verify, analyze, and report directory data on a 90‑day cycle, which could raise plan operating costs and be passed on to enrollees or taxpayers.
Plans that fail to meet the new requirements could face civil monetary penalties or corrective actions, which could reduce plan offerings or prompt higher premiums if compliance risk or costs are shifted to consumers.
Public, machine‑readable provider files and more detailed directory data could enable misuse of provider contact information and raise privacy/security risks for hospitals, health systems, and individual health workers if data stewardship is inadequate.
Based on analysis of 2 sections of legislative text.
Requires certain Medicare Advantage plans to verify and maintain accurate provider directories, flag/remove unverifiable listings, and adds cost-sharing protections for affected enrollees starting plan year 2028.
Introduced September 10, 2025 by James Varni Panetta · Last progress September 10, 2025
Requires certain Medicare Advantage plans to maintain accurate, public provider directories and to verify listed provider information on a set schedule beginning in plan year 2028. Plans must verify listings at least every 90 days (with more frequent checks for hospitals/facilities as set by HHS), flag unverifiable entries, and remove providers within five business days after confirming they no longer participate. The bill also creates explicit cost-sharing protections and notification duties for enrollees who receive care from a nonparticipating provider who was listed in the plan directory on the appointment date.