ACP calls for reform of the Medicare Advantage Program to protect patient health

PHILADELPHIA, May 18, 2026-The Centers for Medicare and Medicaid Services (CMS) should reform Medicare Advantage to protect patient health and realign the plan option with its original purpose, says the American College of Physicians (ACP). In a new paper, "Protecting the Integrity and Quality of the Medicare Advantage Program: A Position Paper from the American College of Physicians" published today in Annals of Internal Medicine, ACP examines the growth of the Medicare Advantage program and its implications for the delivery of fair, high-quality and fiscally responsible care to older adults and people with disabilities.

Medicare Advantage is the private option in Medicare that now enrolls more than half of all Medicare beneficiaries. The plans are offered by private insurers approved by the CMS and integrate Part A and Part B of traditional Medicare coverage into a single plan with additional coverage options, such as prescription drugs, dental, vision and even gym memberships. The additional coverage appeals to beneficiaries, but beneficiaries often face challenges in navigating plan choices, unexpected costs, prior authorization and access to clinicians and post-acute services. These barriers disproportionately affect those who are low-income, live in rural communities, or have several chronic conditions. Medicare Advantage risk adjustment policies have created payment vulnerabilities and favorable patient selection, whereas quality measurement of the plans remains fragmented and overly complex.

"The percent of Medicare beneficiaries enrolled in a Medicare Advantage plan more than doubled between 2010 and 2024. The plans' rising prevalence becomes more concerning because gaps in oversight and fragmented standards means they can lack transparency, create barriers to health, and employ misleading marketing tactics," said Jan K. Carney, MD, MACP, president, ACP, "ACP's recommendations for improving oversight, standardization, and prior authorization processes will mitigate barriers to timely care and reduce administrative burden. We urge CMS to implement our recommendations to protect the Medicare Advantage program and prioritize patient-centered care."

In the paper, ACP details several position statements and recommendations for policymakers to ensure that traditional fee-for-service Medicare remains a strong, sustainable option for beneficiaries and advises that Medicare Advantage plans should not be used to replace or privatize traditional Medicare. These plans also must provide transparent, standardized benefit designs, which would improve beneficiaries' decision making, enhance accountability and ensure that plan offerings prioritize meaningful health benefits rather than serving as an incentive to select a plan. The transparency should extend to the promotion of Medicare Advantage plans, as well. ACP strongly advises robust oversight and regulation of Medicare Advantage marketing practices to prevent misleading advertisements and says that plans engaging in deceptive marketing should face penalties. Medicare Advantage plans should also be required to provide clear, standardized cost disclosures to protect beneficiaries from unexpected financial strain, and CMS should ensure that Medicare Advantage plans prioritize affordability alongside access to care. ACP says the plans should enact balanced and transparent risk adjustment mechanisms to better reflect patient complexity and avoid excessive coding practices.

Prior authorization requirements in Medicare Advantage plans are a common concern for physicians and patients due to administrative burden and potential delays in necessary care; ACP calls for streamlined prior authorization processes with faster response times and improved transparency. ACP also recommends that Medicare Advantage plans offer comprehensive and accessible telehealth options to benefit rural and underserved populations. The plans should also report to CMS and the public on the usage and outcomes of supplemental benefits, such as telehealth, dental, vision and hearing services to ensure accountability. Finally, ACP urges policymakers to prevent restrictive contractual clauses in Medicare Advantage models that interfere with physicians' abilities to serve their patients. Regulatory frameworks should prioritize patient-centered care over administrative or financial considerations.

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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. ACP membership includes 163,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram, Threads and LinkedIn, and subscribe to our new RSS feed.

Contact: Jacquelyn Blaser, [email protected], 202-261-4572