Medicare Advantage plans must now advertise their denial rates
H.R. 6111 — 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. · Filed by Mark Pocan (D-WI) · 17 cosponsors · Introduced Nov 18, 2025 · Referred to committee
Your members of Congress
Enter a ZIP to see where your representative and both senators stood on this bill.
Looked up on this device — your ZIP is never stored on our servers.
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 full analysis lists 4 implications of this text.
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.