Medicare Advantage Improvement Act of 2026

The Medicare Advantage Improvement Act of 2026 aims to speed up care decisions and increase transparency for Medicare Advantage enrollees by establishing strict time limits for insurance plan responses to requests for coverage authorization. Beginning in 2028, plans must provide real-time approvals for low-risk services, respond to other authorization requests within 72 hours, and automatically pay claims for authorized services without manual review. The bill also prohibits plans from requiring new authorizations for clinically necessary changes to already approved treatments and mandates that medical necessity standards match those used in traditional Medicare. To ensure accountability, the legislation introduces a new compliance scoring system that could reduce payments to plans failing to meet these requirements and adds a specific domain to the public star ratings based on adherence to these rules.