To amend title XVIII of the Social Security Act to require any advertisement of a Medicare Advantage plan to include information related to the rates of prior authorization denials under such plan.
Sponsors
Legislative Progress
IntroducedMr. Pocan (for himself, Mr. Carson, Mr. Cohen, Ms. DeLauro, …
Summary
What This Bill Does
This bill requires Medicare Advantage insurance plans to include specific statistics about prior authorization denials in all their advertisements. Starting one year after enactment, every ad must display (both verbally and visually when possible) three key metrics from the most recent plan year: the total number of prior authorization requests that were denied, how many of those denials were overturned on appeal, and the average time it took to approve requests after initially denying them.
Who Benefits and How
Medicare beneficiaries, particularly seniors and disabled individuals shopping for coverage, benefit from this transparency requirement. They will be able to compare plans based on hard data about denial rates rather than relying solely on marketing claims. Plans with low denial rates and efficient appeals processes gain a competitive advantage, as their positive statistics will attract more enrollees. Patient advocacy groups also benefit from increased accountability in the Medicare Advantage marketplace.
Who Bears the Burden and How
Medicare Advantage insurance companies face new compliance costs, as they must track, calculate, and prominently display denial statistics in all advertising materials. Plans with high prior authorization denial rates face reputational risks and potential enrollment losses when their statistics are publicly disclosed. Advertising and marketing agencies working with these plans must redesign campaigns to incorporate the mandatory disclosures, increasing production complexity and costs.
Key Provisions
- Mandates verbal and visual disclosure of prior authorization denial statistics in all Medicare Advantage plan advertisements
- Requires disclosure of three specific metrics: total denials, denials overturned on appeal, and average days to approve after initial denial
- Effective date is one year after enactment, giving plans time to develop tracking systems
- Applies to all advertisements regardless of medium (TV, radio, print, digital, direct mail)
- Uses data from the most recent completed plan year before the advertisement is published
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Requires Medicare Advantage plan advertisements to disclose prior authorization denial rates and approval timelines
Policy Domains
Legislative Strategy
"Increase transparency in Medicare Advantage plan marketing by forcing disclosure of denial rates, potentially steering seniors toward plans with lower denial rates"
Likely Beneficiaries
- Medicare beneficiaries (seniors and disabled individuals) seeking to make informed plan choices
- Patient advocacy groups
- Medicare Advantage plans with low prior authorization denial rates
Likely Burden Bearers
- Medicare Advantage insurance companies (must track, calculate, and disclose denial metrics in all advertisements)
- Medicare Advantage plans with high prior authorization denial rates (reputational risk from disclosure)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "ma_plans"
- → Medicare Advantage plans (private insurance companies offering Medicare benefits)
Key Definitions
Terms defined in this bill
Any advertisement promoting or marketing a Medicare Advantage plan to potential enrollees
Requests requiring health plan approval before receiving certain medical services or treatments, including those initially denied but later approved upon reconsideration
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology