Sponsors (18)
The bill increases transparency about Medicare Advantage prior‑authorization denials—helping beneficiaries compare plans and potentially improving access—while imposing reporting costs, risks of consumer misinterpretation, and privacy/proprietary concerns.
Medicare beneficiaries will get standardized public metrics showing how often Medicare Advantage (MA) plans deny prior‑authorization requests, how often denials are overturned on appeal, and average appeal times, enabling clearer plan comparisons and more informed enrollment and provider choices.
Public reporting of denial, overturn, and appeal-timing metrics could pressure MA plans to reduce unnecessary denials or speed reconsiderations, improving access to care for beneficiaries and reducing delays for people with chronic conditions.
Availability of overturn and timing data helps clinicians and hospitals understand plan behavior and may inform provider referrals and care planning for patients on MA plans.
Medicare Advantage plans will face new compliance and reporting costs to collect, calculate, and include these metrics in advertisements, which could increase administrative spending and ultimately affect premiums, benefits, or taxpayer support.
Summarized metrics in ads may be misinterpreted by consumers who lack clinical or case-mix context, potentially discouraging enrollment in plans that serve sicker or more complex patients and shifting enrollment patterns in ways that harm access.
Disclosure of granular operational metrics could raise privacy or proprietary competitive concerns for plans and providers if data are not carefully de-identified or aggregated, creating legal or market risks.
Based on analysis of 2 sections of legislative text.
MA plan ads must disclose prior-authorization denial counts, reversals, and average time to approval for the most recent completed plan year, starting one year after enactment.
Official title: To amend title XVIII of the Social Security Act to require any advertisement of a Medicare Advantage plan to include information related to the rates of prior authorization denials under such plan.
Introduced November 18, 2025 by Mark Pocan · Last progress November 18, 2025
Requires Medicare Advantage plan ads to include both spoken and visual disclosures, starting one year after enactment, showing prior-authorization denial data for the most recent completed plan year: total denials (including those later overturned), number of denials that were reconsidered and approved, and the average days between initial denial and eventual approval. The goal is to make prior-authorization practices more transparent to current and prospective enrollees.