Medicare Advantage Improvement Act of 2026
April 20, 2026
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The Frame
If passed, this bill would legally mandate that insurance plans provide faster decisions on medical coverage requests for millions of seniors and disabled enrollees starting in 2028.
Potentially affected actors named in the source documents. Mention is not a position.
Medicare Advantage Enrollees
Patients enrolled in these plans will have legally mandated timeframes for insurance coverage decisions regarding their medical care.
Medicare Advantage Organizations
Insurance companies offering these plans must update their internal authorization processes and increase their public data reporting.
Healthcare Providers
Doctors and hospitals will receive faster notifications regarding coverage determinations for their patients.
Last recorded activity April 20, 2026.
Introduced.
Summary
Key Facts
- Requires Medicare Advantage plans to respond to standard authorization requests within 72 hours starting January 1, 2028.
- Requires Medicare Advantage plans to respond to expedited authorization requests within 24 hours starting January 1, 2028.
- Allows plans to extend the 72-hour deadline by up to 7 days if the patient requests it, if medical evidence is needed from an out-of-network provider, or due to extraordinary circumstances.
- Mandates that Medicare Advantage plans report prior authorization data at the plan and parent-organization level, not just the contract level, starting in 2028.
- Requires prior authorization data to be published in a downloadable format for research and oversight purposes.
- Requires plans to implement a mechanism for real-time authorization decisions for specific identified services starting January 1, 2028.
- Grants the Secretary of Health and Human Services authority to adjust these deadlines through rulemaking starting January 1, 2030.
- Defines 'specified authorization' to include prior authorizations, preservice determinations, concurrent determinations, and hospital/post-acute care transfers.
Why It Matters
If passed, this bill would legally mandate that insurance plans provide faster decisions on medical coverage requests for millions of seniors and disabled enrollees starting in 2028.
Frequently Asked Questions
When would these new rules take effect?
Can my insurance plan take longer than 72 hours to approve a request?
Does this apply to all Medicare plans?
News Coverage
Lobbying Activity
AARP
2026
“P.L. 119-21, One Big Beautiful Bill Act H.R. 8867, Planning for Long-term Aging Needs (PLAN) Act H.R. 5861, Legacy Act of 2025 H.R. 9393, the Lower Costs, More Transparency Act. H.R. 9396, the Prior Authorization Accountability Act. S. 4916, the Aging with Artificial Intelligence Act. H.R. 8100, Safe Staffing Saves Lives Act. S. 3886, Nurses Belong in Nursing Homes Act. H.R. 6766/S. 3492, the Essential Caregivers Act of 2025. H.R. 7966/S. 4118, Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act. S. 2120, the Older Americans Act Reauthorization Act of 2025 H.R. 5575, the Firefighters Assisting Seniors to Emergency Response (FASTER) Act of 2025. H.R. 3954/S. 4641, Improving Access to Medicare Coverage Act. H.R.5554/S.2831, Stand Strong for Medicare Act. S. 3439/H.R. 6735, Connecting Caregivers to Medicare Act and efforts related to the bill S. 1227/H.R. 2491, Alleviating Barriers for Caregivers Act S. 668/H.R. 3183, Supporting Access to Falls Education and Prevention and Strengthening Training Efforts and Promoting Safety Initiatives (SAFE STEPS) for Veterans Act of 2025 CMS-1851-P, Hospice Proposed rule. CMS-1843-P, Skilled Nursing Facility Proposed rule. CMS-1844-P, Home Health Proposed rule. No bill number. Health care transparency. No bill number. Discussed use of artificial intelligence and health data technology. No bill number. Discussed health-related policies and activities around the fall respiratory virus season. No bill number. Discussed health insurance affordability proposals. No bill number. Discussed Nursing Home staffing standards, safety, and quality. No bill number. Discussed Nursing home transparency and ownership requirements. No bill number. Discussed home health, hospice, and long-term care. No bill number. Discussed falls prevention. No bill number. Discussed social isolation. No bill number. Discussed HUD Assisted Living Requirements No bill number. Discussed family caregiving. No bill number. Discussed AARP paper on Medicare Caregiver Training Services. No bill number. Discussed Medicaid community engagement interim final rule, including the family caregiver exemption. No bill number. Discussed the paid direct care workforce in long-term care. No bill number. Discussed the unaffordability of long-term care. No bill number. Discussed Money Follows the Person Rebalancing Demonstration Program and Medicaid HCBS spousal impoverishment protections. No bill number. Discussed Medicaid fraud and family caregivers, Medicaid self-direction programs. No bill number. Discussed sandwich generation family caregiver hearing and submitted a statement for the record discussing family caregivers and sandwich generation caregivers, programs that support them, AARP caregiving resources, and federal policies to support sandwich generation caregivers and caregivers more broadly. No bill number. Discussed long-term care. No bill number. CMS-2453-NC; Medicaid Program; 2028 Medicaid Home and Community-Based Services Quality Measure Set Submitted comments No bill number. Discussed expanding access to home care. No bill number. Discussed the increasing cost of home care No bill number. Discussed HSA use for telehealth chronic care management services/subscriptions. No bill number. Discussed artificial intelligence and technology”
Sponsors
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Shift toward real-time automation
The bill explicitly mandates the implementation of real-time authorization mechanisms using certified EHR technology, signaling a legislative push to digitize and automate insurance approvals.
Connected Entities
Analysis Score
0–100- Significance85How much this matters to a regular citizen
- Controversy40Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz30Current news / social attention level
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