Medicare Advantage changes could cut extra benefits but speed up care approvals for millions under new bill

Medicare Advantage could be headed for one of its biggest shakeups in years as lawmakers push a bipartisan reform bill while insurers warn that popular extra benefits may be reduced next year.

The combination of stricter oversight in Washington and tighter insurer budgets could affect tens of millions of older Americans who rely on private Medicare plans.

The proposed Medicare Advantage Improvement Act of 2026 would increase consumer protections, shorten prior authorization timelines, and limit plan practices that critics say delay care.

At the same time, insurers including Humana have signaled that lower-than-expected government payment increases may force cuts to supplemental benefits in 2027.

Why Medicare Advantage is under growing pressure

More than half of Medicare-eligible Americans are now enrolled in Medicare Advantage plans, which are operated by private insurers under federal contracts. The plans have grown rapidly because they often include benefits not found in traditional Medicare, such as dental, vision, hearing, fitness memberships, meal delivery, and transportation assistance.

But as enrollment has surged, lawmakers and healthcare providers have raised concerns about delayed approvals, denied claims, and barriers to treatment.

What the new House bill would change

The Medicare Advantage Improvement Act of 2026 was introduced in the U.S. House by a bipartisan group of lawmakers, many of whom are physicians. Supporters say the legislation is aimed at bringing Medicare Advantage rules closer to traditional Medicare standards.

Among the key provisions, plans would be prohibited from using coverage criteria more restrictive than traditional Medicare. The bill would also create clearer timelines for decisions on patient care requests.

One of the bill’s biggest changes would impose strict deadlines for prior authorization responses. Medicare Advantage plans would need to answer standard requests within 72 hours and expedited requests within 24 hours.

Advocates say these timelines could help seniors avoid dangerous delays when trying to access treatments, rehabilitation services, or specialist care.

Limits on repeated approvals and payment denials

The legislation would also restrict prior authorization when a service has already been approved or when clinicians make medically necessary adjustments to care plans.

In addition, insurers would be barred from denying payment after treatment was previously authorized. Supporters say this would reduce confusion for providers and protect patients from disruptions in care.

“Medicare is a promise to America’s seniors that they will have dependable access to quality healthcare in their later years. However, that promise has been undermined by unnecessary barriers to care – particularly through excessive use of prior authorization and inappropriate coverage denials in Medicare Advantage,” Representative John Joyce, who in part introduced the bill, said in a statement.

“The Medicare Advantage Improvement Act will restore accountability, reduce unnecessary barriers and ensure that seniors receive timely, high-quality care.”

Industry experts say reform targets gatekeeping. This isn’t about taking away benefits. It’s about forcing insurers to stop weaponizing prior authorization. Medicare Advantage covers 35 million seniors now, and insurers systematically delay or deny post-acute care requests at rates far exceeding approvals for other services. The bill directly targets that practice.”

Providers welcome broad reform push

Healthcare providers, especially those in long-term care and home health, have broadly praised the proposal. Many have argued that delayed approvals under Medicare Advantage have created serious operational and patient care problems.

The healthcare providers are in favor of developing a better way to enable seniors to have timely access to care and hold plans accountable.

Insurers may resist new restrictions

Health insurers have long argued that prior authorization and care management tools help control healthcare spending and improve coordination of services.

The new bill does not eliminate prior authorization entirely, but it would significantly limit how plans can use it. That could set up a lobbying battle as the legislation moves through Congress.

Separately, insurers are warning that supplemental benefits may be cut next year after the U.S. government announced a 2.48% average increase in 2027 Medicare Advantage payments.

Executives say the increase is better than first proposed but still may not fully cover rising medical costs. As a result, insurers could scale back extras such as dental, vision, hearing, transportation, meals, and gym memberships.

Humana said it would need to cut benefits to meet long-term profitability goals.

“We will adjust benefits to remain on track to deliver our 2028 commitment of returning to a sustainable margin of at least 3%,” said CEO Jim Rechtin.

Investors also suggested competitors including UnitedHealthcare and CVS Health’s Aetna could make similar adjustments or pull back in certain markets.

Political fallout could build before midterms

Medicare Advantage enrollment begins in October, shortly before U.S. midterm elections. Because older Americans vote in large numbers, higher out-of-pocket costs or reduced benefits could become a political issue.

The House bill has been referred to committee, and no timeline has been set for a floor vote. Even if enacted, implementation would likely take time.

For now, Medicare Advantage members face two parallel realities: possible stronger protections against delays and denials, but also the prospect of fewer extra benefits in 2027 as insurers adapt to changing economics.

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