Senators Marshall & Whitehouse Introduce Bill to Fix Medicare Advantage for Seniors

Washington - On Monday, U.S. Senator Roger Marshall, M.D. (R-Kansas) and Sheldon Whitehouse (D-Rhode Island) introduced the Medicare Advantage Improvement Act, bipartisan legislation designed to reform Medicare Advantage (MA) and ensure seniors receive the reliable, patient-centered care the program promises.

Medicare Advantage now serves more than half of all Medicare beneficiaries-and that number is growing. But as enrollment has surged, so have reports of delayed approval, surprise denials, confusing appeals processes, and disruptions to care that seniors depend on. This bill directly addresses these failures while preserving the benefits and flexibility that make Medicare Advantage popular.

"As a physician and someone who ran a hospital, I've seen firsthand what happens when bureaucratic barriers get between a patient and the care they need - and it is not acceptable," said Senator Marshall. "This bill makes expectations clearer, timelines shorter, and protections stronger. It fixes what's broken without changing what's working. Our seniors deserve better, and this bill delivers."

"Americans are rightfully fed up with health care bureaucracy, and prior authorization is one of the worst offenders: delaying treatment, driving up costs, and putting paperwork ahead of patients. We need to cut this red tape so providers can deliver timely, high-quality care," said Senator Whitehouse.

The bill was introduced in the House of Representative last week by Reps. John Joyce, M.D. (R-Pennsylvania), Kim Schrier, M.D. (D-Washington), Greg Murphy, M.D. (R-North Carolina), Jimmy Panetta (D-California), Mariannette Miller-Meeks, M.D. (R-Iowa), and Ami Bera, M.D. (D-California), and Beth Van Duyne (R-Texas).

What the Medicare Advantage Improvement Act does:

• Requires standard prior authorization approvals within 72 hours, expedited decisions within 24 hours, and real-time approvals for routine low-risk services integrated with electronic health records-and once care is approved, plans cannot require new authorizations mid-treatment.
• Once a service is authorized, coverage cannot be retroactively denied (except for fraud or error), automated denial algorithms are prohibited, and prompt-pay protections ensure providers are reliably compensated for approved care.
• Requires MA plans to publicly report detailed prior authorization data, giving patients, providers, and policymakers the information they need to hold plans accountable.
• Prevents MA plans from applying stricter medical necessity standards than original Medicare and codifies clear inpatient admission standards to protect seniors from unexpected costs and coverage disputes.
• Strengthens network adequacy requirements for rehabilitation hospitals and long-term care hospitals, improving access to post-acute care for seniors recovering from serious illness or injury.

Background:

• Senator Marshall leads the bipartisan, bicameral Improving Seniors' Timely Access to Care Act alongside Senator Warner-legislation to streamline the prior authorization process for MA enrollees.
• When insurers failed to comply with the original No Surprises Act, Senator Marshall introduced the bipartisanNo Surprises Act Enforcement Act to close enforcement gaps, increase penalties for non-compliant payers, and strengthen transparency requirements.

Click here to read the full text of the legislation.

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