Medicare Advantage plans must now keep provider lists accurate or pay the price

What it does

This bill requires Medicare Advantage plans to maintain accurate, publicly available provider directories and verify provider information at least every 90 days starting in 2028. If a patient sees a doctor listed in the directory who turns out not to be in the plan's network, the patient pays only the in-network cost-sharing amount. Plans must report accuracy scores to the government, which will be published publicly so beneficiaries can compare plans.

Why we flagged it

The bill's operative mechanism is a patient-protection mandate: it requires MA plans to maintain accurate directories and shields patients from cost-sharing penalties when they rely on inaccurate information. The secondary mechanism—transparency through published accuracy scores—supports informed plan selection.

What the text implies

• Plans may face significant administrative costs to verify provider status every 90 days across large networks; these costs may be passed to enrollees through higher premiums or reduced benefits, offsetting some patient protection gains.
• The bill defines 'specified MA plans' narrowly (network-based plans and certain fee-for-service plans), leaving other MA plan types unaffected; beneficiaries in excluded plan types retain no new protections.
• Accuracy scores are published starting 2029 but the bill does not specify enforcement mechanisms or penalties if plans fail to meet accuracy standards, potentially limiting real-world compliance.
• Mental health and substance use disorder providers are explicitly called out for high inaccuracy rates, but the bill does not mandate corrective action if those specialties show persistent inaccuracy.

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

Who it affects

Medicare Advantage enrollees gain concrete protections: they avoid surprise out-of-network costs when relying on inaccurate directories, and they gain transparency through published accuracy scores to compare plans. The bill shifts accountability to plans to maintain accurate information, reducing patient harm from directory errors.

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Medicare Advantage organizations, Secretary of Health and Human Services, Comptroller General of the United States, National Plan and Provider Enumeration System, Assistant Secretary for Technology Policy, Office of the National Coordinator for Health Information Technology

Where it stands

2 cosponsors: 1 Democrats, 1 Republicans.

• Jan 29, 2026 — Introduced · Congress.gov: “Introduced in Senate”
• Jan 29, 2026 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

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