Sponsors (18)
The bill increases transparency about MA prior‑authorization denials—helping beneficiaries compare plans and potentially improving access—at the cost of added plan administrative burdens, risks of consumer misinterpretation, and privacy/proprietary concerns.
Medicare beneficiaries will get clear, comparable information on how often Medicare Advantage (MA) plans deny prior‑authorization requests, how often denials are reversed, and appeal timelines, enabling beneficiaries (especially those choosing plans) to compare plans and make more informed enrollment and care decisions.
MA enrollees and patients (including those with complex or chronic conditions) may experience improved access to care if public reporting pressures plans to reduce unnecessary denials or speed reconsiderations.
Medicare beneficiaries (and taxpayers indirectly) may face higher administrative costs because MA plans must collect, calculate, and include new metrics in advertising, which could raise plan expenses and be passed along in premiums or plan design.
Medicare beneficiaries—particularly those with complex needs—could be misled by summary metrics in advertisements that lack clinical context (e.g., case mix), potentially discouraging enrollment in plans that serve sicker patients.
Hospitals, providers, and MA plans could face privacy or proprietary/competitive risks if granular operational metrics are not properly de‑identified or aggregated before disclosure.
Based on analysis of 2 sections of legislative text.
Requires Medicare Advantage plan ads, starting one year after enactment, to disclose prior-authorization denial counts, how many denials were later approved on reconsideration, and the average days to approval.
Introduced November 18, 2025 by Mark Pocan · Last progress November 18, 2025
Requires Medicare Advantage (MA) plan advertisements to include both spoken and visual disclosures, starting one year after enactment, about prior authorization denials from the most recent completed plan year. Ads must report: the number of prior-authorization requests denied (including those later reversed on reconsideration), the number of denials that were later approved on reconsideration, and the average number of days between initial denial and eventual approval. The change targets MA plan marketing materials and aims to give enrollees and potential enrollees clearer information about how often the plan denies prior authorization and how long approvals take after reconsideration. Plans will need to collect, calculate, and present these statistics in future advertisements.