Medicare Advantage plans face payment cuts for slow approvals and improper denials
S. 4384 — Medicare Advantage Improvement Act of 2026 · Filed by Roger Marshall (R-KS) · 3 cosponsors · Introduced Apr 27, 2026 · Referred to committee
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What it does
This bill tightens Medicare Advantage (MA) plan rules to speed up authorization decisions, improve transparency, and penalize plans that deny coverage improperly. Starting in 2028, MA plans must approve or deny routine requests within 72 hours (24 hours for urgent cases), publish their approval rates publicly, and cannot deny claims after approving them or require new authorizations for clinically necessary changes to approved services. Plans that fail compliance audits face payment cuts of 1–2%.
Why we flagged it
The bill's core function is to enforce faster authorization decisions, prevent retroactive denials, and create financial penalties for non-compliant MA plans. It is regulatory enforcement and consumer protection, not a subsidy or carve-out.
What the text implies
- MA plans may respond by narrowing networks or raising premiums to offset 1–2% payment reductions, shifting costs to beneficiaries indirectly.
- Real-time authorization requirements may force plans to invest in EHR integration and automated approval systems, raising operational costs that could be passed to enrollees.
The full analysis lists 4 implications of this text.
Who stands to gain
Medicare beneficiaries (faster care access, stronger protections); Healthcare providers (faster payment, reduced prior-auth burden); Independent review entities (expanded appeals workload)