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.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The bill requires Medicare Advantage plans to disclose prior authorization denial statistics in all advertisements, including total denials, overturned denials, and average reversal processing time. It relies on reporting requirements and compliance mandates. The main policy areas are Finance, Healthcare, and Trade.
Who Benefits and How
Medicare Advantage plans with low denial rates and fast appeals processing could gain revenue opportunities.
Who Bears the Burden and How
Medicare Advantage insurance plans (private insurers offering Medicare coverage) would take on compliance duties, Medicare Advantage plans with high prior authorization denial rates could face increased risk, and Advertising and marketing agencies serving Medicare Advantage plans would take on compliance duties.
Key Provisions
- Requires Medicare Advantage plans to disclose prior authorization denial statistics in all advertisements, including total denials, overturned denials, and average reversal processing time.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill requires Medicare Advantage plans to disclose prior authorization denial statistics in all advertisements, including total denials, overturned denials, and average reversal processing time.
Key Policy Areas
Finance, Healthcare, Trade
Primary Purpose
The bill requires Medicare Advantage plans to disclose prior authorization denial statistics in all advertisements, including total denials, overturned denials, and average reversal processing time.
Policy Domains
Full Bill - Medicare Advantage Advertising Requirements
Identified Gains
- Medicare Advantage plans with low denial rates and fast appeals processing
Identified Costs
- Medicare Advantage insurance plans (private insurers offering Medicare coverage)
- Medicare Advantage plans with high prior authorization denial rates
- Advertising and marketing agencies serving Medicare Advantage plans
Sponsors
Legislative Progress
IntroducedMr. Pocan (for himself, Mr. Carson, Mr. Cohen, Ms. DeLauro, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Medicare Advantage insurance plans (private insurers offering Medicare coverage), Medicare Advantage plans with high prior authorization denial rates, Medicare Advantage plans with low denial rates and fast appeals processing
Positive-direction: Medicare Advantage plans with low denial rates and fast appeals processing
Negative-direction: Medicare Advantage insurance plans (private insurers offering Medicare coverage), Medicare Advantage plans with high prior authorization denial rates
Advertising and marketing agencies serving Medicare Advantage plans
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