Congressman Mark Pocan (D-WI), along with 12 other members of the House, on November 19, 2025 introduced a package of eight bills that seek to restrain certain Medicare Advantage (MA) plan practices and strengthen the core Medicare program. The bills would establish a series of new requirements for MA plans including:
- Automatic appeals to be processed without beneficiary action when a prior authorization is denied,
- Requiring CMS to terminate MA plans if more than 25% of their prior authorization denials are reversed upon appeal,
- Requiring plans to disclose their coverage determination delay and denial rates when they advertise their plans,
- Preventing MA plans from overcharging taxpayers, which is supported by MedPAC reports,
- Prohibiting MA from becoming the default enrollment option for Medicare beneficiaries,
- Requiring CMS to create a national, user-friendly website where individuals can look up their healthcare providers by insurance plan.
LeadingAge will follow these bills closely and look forward to engaging with the sponsors on their content.