Congress cuts Medicare Advantage payments—but plans may cut benefits instead
H.R. 9544 — Save MEDICARE Act of 2026 · Filed by Lloyd Doggett (D-TX) · 52 cosponsors · Introduced Jun 30, 2026 · Referred to committee
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What it does
The Save MEDICARE Act restructures how Medicare Advantage (MA) plans are paid by the federal government, starting in 2028. It removes certain diagnosis codes that MA plans may be gaming to inflate payments, adjusts benchmark payments downward to account for healthier enrollees choosing MA over traditional Medicare, tightens audits of MA plan billing, and requires MA and prescription drug plans to reimburse the VA when they cover care for veterans. The bill also gives states enforcement power over MA plans and bans providers from being paid bonuses based on coding volume.
Why we flagged it
The bill's core function is to reduce Medicare Advantage plan payments through diagnosis-code exclusions, favorable-selection adjustments, and tighter audits, while expanding VA cost-recovery rights. It is not primarily about protecting beneficiaries from deception (despite the title's framing) but rather about controlling MA plan payments and shifting costs.
- Section 6 (Guard Veterans Health Care Act) requires MA and PDP plans to reimburse VA for covered care. This is substantively unrelated to Medicare Advantage payment reform and appears to be a separate policy objective bundled into the bill.
What the text implies
- MA plans may respond to lower payments by narrowing provider networks, reducing supplemental benefits, or increasing cost-sharing—shifting financial burden to beneficiaries, especially those with chronic conditions who cannot easily switch.
- The diagnosis-code exclusions and favorable-selection adjustments may disproportionately affect sicker beneficiaries if MA plans exit markets or reduce coverage in high-cost areas.
The full analysis lists 5 implications of this text.
Who stands to gain
Department of Veterans Affairs (cost recovery); Centers for Medicare & Medicaid Services (audit enforcement); Recovery audit contractors (contingency fees up to 20%)