Medicare Advantage plans must now advertise their denial rates

What it does

This bill requires Medicare Advantage (MA) plans to disclose in all advertisements how often they deny prior authorization requests for medical care. Starting one year after enactment, every MA plan ad must show the number of denials, how many were later overturned on appeal, and the average time between initial denial and approval. This gives seniors concrete data about plan gatekeeping practices before they enroll.

Why we flagged it

The bill's sole operative mechanism is a disclosure requirement—it mandates that MA plans publish specific gatekeeping metrics in advertisements. It does not restrict plan behavior, cap denials, or impose penalties; it simply requires transparency about existing denial practices.

What the text implies

• MA plans may respond by improving appeal processes or reducing denials to avoid negative advertising optics, creating indirect behavioral incentive without regulatory mandate.
• Disclosure requirement applies only to advertisements, not to enrollment materials or plan documents—seniors must actively encounter ads to see denial data; passive plan shoppers may miss it.
• The 1-year implementation lag means current enrollees will not see denial data for their own plans until 2026 at earliest, limiting near-term impact on plan switching.
• Plans may comply with 'verbal and visual disclosure (to the extent possible)' language by burying metrics in fine print or fast-spoken disclaimers, potentially undermining transparency intent.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Medicare beneficiaries gain material information about plan gatekeeping practices—denial rates, appeal success, and appeal delays—enabling informed plan selection. This addresses an information asymmetry: seniors currently cannot easily compare plans on how aggressively they deny care requests, a key quality metric affecting access to treatment.

Named in the bill

Medicare Advantage plans, Centers for Medicare & Medicaid Services (CMS), Social Security Act Section 1852(c), Medicare beneficiaries

Where it stands

17 cosponsors: 17 Democrats.

• Nov 18, 2025 — Introduced · Congress.gov: “Introduced in House”
• Nov 18, 2025 — Referred to House Committee on Energy and Commerce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

2 lobbying clients named this bill on 2 disclosure filings across 1 quarter, Dec 2025 to Dec 2025. Those filings disclosed $40,000 in lobbying spend. A filing names 18 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 41% of bills with at least one filing.

Mark Pocan, the sponsor, reported $474,320 in PAC receipts in the 2026 cycle.

• Center for Health and Democracy — $20,000 on 1 filing
• Social Security Works — $20,000 on 1 filing

Lobbying Disclosure Act filings through Jan 16, 2026. A filing shows who paid to lobby on a bill it names, not what changed.