Slate of Medicare Advantage Reform Bills Introduced in House

Congressman Mark Pocan(D-WI), along with 12 other members of the House, on November 19, 2025 introduced a package of eight bills that seek to restrain certain Medicare Advantage (MA) plan practices and strengthen the core Medicare program. The bills would establish a series of new requirements for MA plans including:

• Automatic appeals to be processed without beneficiary action when a prior authorization is denied,
• Requiring CMS to terminate MA plans if more than 25% of their prior authorization denials are reversed upon appeal,
• Requiring plans to disclose their coverage determination delay and denial rates when they advertise their plans,
• Preventing MA plans from overcharging taxpayers, which is supported by MedPAC reports,
• Prohibiting MA from becoming the default enrollment option for Medicare beneficiaries,
• Requiring CMS to create a national, user-friendly website where individuals can look up their healthcare providers by insurance plan.

LeadingAge will follow these bills closely and look forward to engaging with the sponsors on their content.