Medicare Advantage plans must now automatically review denied claims
H.R. 6110 — To amend title XVIII of the Social Security Act to require Medicare Advantage plans to automatically reconsider determinations denying coverage. · Filed by Mark Pocan (D-WI) · 17 cosponsors · Introduced Nov 18, 2025 · Referred to committee
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What it does
This bill requires Medicare Advantage plans to automatically reconsider coverage denials without waiting for patients to request it. Currently, plans only reconsider denials when a patient asks; this bill makes reconsideration automatic and immediate, giving patients a second look at denied claims as a matter of course rather than requiring them to navigate the appeals process themselves.
Why we flagged it
The bill's sole operative effect is to shift Medicare Advantage reconsideration from opt-in (patient-initiated) to automatic (plan-initiated), a procedural protection that reduces barriers to coverage review for beneficiaries.
What the text implies
- Automatic reconsideration may increase administrative costs for Medicare Advantage plans, potentially affecting plan profitability and premium pricing in future years.
- The bill does not specify a timeline for automatic reconsideration, leaving implementation details to CMS regulation — the actual speed of review depends on future rulemaking.
The full analysis lists 3 implications of this text.
Who it affects
Patients with denied Medicare Advantage claims receive automatic reconsideration without having to navigate appeals procedures themselves, reducing barriers to coverage and improving access to care. The burden of initiating review shifts from individual patients to plans, lowering friction and ensuring no denial goes unreviewed.