Medicare Advantage plans must stop hiding outdated doctor lists
H.R. 5281 — REAL Health Providers Act · Filed by Jimmy Panetta (D-CA) · 8 cosponsors · Introduced Sep 10, 2025 · Referred to committee
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What it does
This bill requires Medicare Advantage plans to maintain accurate, publicly available provider directories and update them at least every 90 days (or annually for hospitals). Starting in 2028, if a patient sees a doctor listed in the plan's directory who turns out not to be in the network, the patient pays the in-network cost-sharing amount instead of the higher out-of-network rate. Plans must also conduct annual accuracy audits and report scores to Medicare, which will be published publicly by 2029.
Why we flagged it
The bill's core function is to protect Medicare Advantage enrollees from financial harm caused by inaccurate provider directories through cost-sharing caps and transparency requirements. It is fundamentally a consumer-protection and information-disclosure measure, not a subsidy or deregulation.
What the text implies
- Plans may respond by reducing network size or negotiating stricter data-sharing agreements with providers, potentially narrowing patient choice in some markets.
- The 90-day update requirement and accuracy audits create ongoing operational costs for MA plans, which may be passed to enrollees through higher premiums or reduced benefits in non-protected areas.
The full analysis lists 4 implications of this text.
Who stands to gain
Medicare Advantage enrollees (through cost-sharing protections); Health IT vendors (data standardization and verification tools); Patient advocacy organizations (transparency and leverage)