The Medicare Advantage Improvement Act of 2026 makes significant reforms to Medicare's private insurance program to improve care access and protect beneficiaries. Starting January 1, 2028, the bill requires Medicare Advantage plans to authorize routine medical services much faster—within 72 hours for standard requests and 24 hours for urgent cases—while implementing automated systems for low-risk services and prohibiting unnecessary repeat authorizations. The law also accelerates the appeals process for denied claims, requiring independent review within 7 to 14 days for standard cases and 24 hours for urgent situations. To ensure compliance, the bill establishes a new scoring system that penalizes underperforming plans with payment reductions of 1 to 2 percent and creates public transparency through expanded Star Ratings so beneficiaries can compare plan quality. Additionally, the legislation restricts plans' ability to retroactively deny previously authorized services, requires plans to pay all authorized claims in full, and expands network requirements to ensure adequate access to specialized post-acute care facilities like long-term care hospitals and rehabilitation centers.
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