H.R. 10394

Highlight any text to annotate

This bill would restrict how Medicare Advantage insurance plans can deny coverage or reject claims for approved medical services. Starting January 1, 2028, once a Medicare Advantage plan approves coverage for a treatment or service either before it begins or while the patient is receiving it, the plan would be prohibited from later denying the claim based on lack of medical necessity, reopening the coverage decision without good cause, or changing billing codes to reduce payment. The only exceptions would be if the plan finds reliable evidence of fraud or similar misconduct, or has good cause as defined in federal regulations. The legislation affects the roughly 28 million seniors and disabled individuals enrolled in Medicare Advantage plans nationwide. The bill has no specific funding requirements since it operates through existing Medicare Advantage plan contracts rather than new appropriations.

Add a comment

Sign in to comment on this bill.

Annotate the text

Highlight any passage on the Summary or Full Text tab to attach a note. Annotations appear on the Annotations tab.