Medicare Advantage could be headed for one of the biggest shakeups in years as insurers warn the popular extra benefits could be cut next year and lawmakers consider a bipartisan reform bill.
The combination of tighter oversight in Washington and tighter insurance budgets could impact tens of millions of older Americans who rely on private Medicare plans.
The proposed Medicare Benefits Enhancement Act of 2026 would increase consumer protections, shorten prior authorization periods 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 could lead to cuts in additional benefits in 2027.
Why is Medicare Advantage under increasing pressure?
More than half of Medicare-eligible Americans are now enrolled in Medicare Advantage plans operated by private insurance companies 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 grown, lawmakers and health care providers have raised concerns about delayed approvals, denied requests and barriers to treatment.
What will the new Parliament bill change?
The Medicare Benefits Enhancement Act of 2026 was introduced in the U.S. House of Representatives by a bipartisan group of lawmakers, most of whom are doctors. Supporters say the legislation aims to bring Medicare Advantage rules closer to traditional Medicare standards.
Among the key provisions, plans would be prohibited from using more restrictive coverage criteria than traditional Medicare. The bill would also create clearer timelines for decisions on patient care requests.
One of the biggest changes in the bill would impose strict deadlines for prior consent responses. Medicare Advantage plans will be required to respond to standard requests within 72 hours and expedited requests within 24 hours.
Advocates say these timelines can help seniors avoid dangerous delays when trying to access treatments, rehabilitation services or specialist care.
Limitations on duplicate approvals and payment rejections
The legislation would also restrict prior authorization if a service has already been approved or if clinicians are making medically necessary adjustments to care plans.
Insurers would also be prohibited from refusing to pay for treatment once it has been previously authorized. Supporters say it will reduce confusion for providers and protect patients from disruptions in care.
“Medicare is a promise to America’s seniors that they will have reliable access to quality health care for years to come. But that promise has been undermined by unnecessary barriers to care, particularly through the overuse of prior authorizations and improper insurance denials in Medicare Advantage,” Rep. John Joyce, who introduced the bill in part, said in a statement. he said.
“The Medicare Benefits Improvement Act would restore accountability, reduce unnecessary barriers, and ensure seniors receive timely, high-quality care.”
Industry experts say the reform is aimed at threshold protection. This is not about eliminating benefits. This is about forcing insurance companies to stop using preauthorization as a weapon. Medicare Advantage currently covers 35 million seniors, and insurers systematically delay or deny claims for post-acute care at rates that far exceed approvals for other services. “The bill directly targets this practice.”
Providers welcome broad reform efforts
Health care providers, especially those providing long-term care and home health services, generally praised the proposal. Many have argued that delayed approvals under Medicare Advantage create serious operational and patient care problems.
Healthcare providers are in favor of developing a better way to ensure seniors can access care in a timely manner and that plans are held 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 doesn’t completely eliminate prior authorization, but it would significantly limit how plans can use it. This could set off a lobbying war as the legislation moves through Congress.
Separately, insurers are warning that additional benefits could be cut next year after the U.S. government announced a 2.48% average increase in 2027 Medicare Advantage payments.
Administrators say the increase is better than first proposed but still may not fully cover rising medical costs. As a result, insurers will be able to reduce extras such as dental, vision, hearing, transportation, meals and gym memberships.
Humana said it needed to cut benefits to meet long-term profitability goals.
“We will adjust our benefits to keep them on track to meet our commitment to return to sustainable margins of at least 3% in 2028,” said CEO Jim Rechtin.
Investors also suggested that rivals such as UnitedHealthcare and CVS Health’s Aetna could make similar adjustments or pull back in certain markets.
Political repercussions may increase before midterms
Medicare Advantage enrollment begins in October, shortly before the U.S. midterm elections. Because older Americans vote in large numbers, increased out-of-pocket expenses or decreased 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 it becomes law, implementation is likely to 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 the changing economy.
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John Dealbreuin came to the United States from a third world country without knowing anyone and with only $1,000; Guided by an immigrant dream. He reached his retirement number in 12 years.
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