Medicare Advantage plans must pay doctors faster—or face penalties
H.R. 5454 — Medicare Advantage Prompt Pay Act · Filed by Jodey Arrington (R-TX) · 19 cosponsors · Introduced Sep 18, 2025 · Referred to committee
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What it does
This bill requires Medicare Advantage organizations to pay healthcare provider claims faster and more reliably. Specifically, MA plans must pay at least 95% of valid claims within 14 days (if submitted electronically) or 30 days (if submitted by other means), and must pay interest on late claims. The bill also imposes civil penalties up to $25,000 per violation and requires MA plans to publicly report their payment performance data.
Why we flagged it
The bill's core mechanism is a regulatory mandate on payment speed and transparency for a specific insurance sector (Medicare Advantage), paired with enforcement penalties and public reporting. It is fundamentally a consumer-protection and provider-protection rule, not a subsidy, tax carve-out, or commemorative act.
What the text implies
- MA plans may respond by tightening network contracts or reducing out-of-network coverage to minimize the 30-day payment obligation, potentially narrowing beneficiary choice.
- Interest penalties (tied to federal prompt-payment rates) may incentivize MA plans to invest in claims-processing automation, raising barriers to entry for smaller, less-capitalized MA competitors.
The full analysis lists 4 implications of this text.
Who stands to gain
healthcare providers and suppliers (faster cash flow, reduced billing disputes); Medicare beneficiaries (indirectly, via more stable provider networks and lower administrative overh