A Democratic bill with 3 Republican cosponsors · See all 5 cosponsors
Last activity — Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
In committee
Introduced and handed to a committee in the chamber it started in.
The committee holds it, and most bills are never heard from again. A hearing or a committee vote would be news; silence is the usual outcome, and it kills the bill without anyone voting against it.
Its path through Congress
- Introduced
- In Committee
What this bill would do
This bill is called the Protecting Approved Care Act. It sets new rules for Medicare Advantage plans regarding prior authorization and claims denials. Starting in plan year 2028, the bill places limitations on when these plans can deny coverage for items and services. It prevents plans from denying coverage after they have already approved an item or service. It also stops plans from denying coverage for services that did not require authorization in the first place.
Yes· 3 of 6
- Scored +7
Would people over 65 be better off under this?
The bill directly benefits seniors enrolled in Medicare Advantage by restricting unfair claim denials and retroactive coverage changes.
- Scored +7
Would retired people be better off under this?
Retirees on Medicare Advantage plans gain stronger consumer protections against post-service claim denials and payment code reductions.
- Scored +6
Does this give people more protection from unfair business practices?
The bill protects Medicare Advantage enrollees by preventing insurers from denying coverage for approved or un-prior-authorized care based on medical necessity.
The opposite
No question was scored the opposite.
Who it would affect, and how
Potential Positive Impacts for People
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Protection After Approval: Under section 1857(e)(7)(A)(i), if a Medicare Advantage plan approves an item or service through a prior authorization or a concurrent determination, the plan cannot later deny coverage for it based on a lack of medical necessity. This protects people from having coverage pulled out from under them after getting the green light.
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Protection for Unrestricted Services: Under section 1857(e)(7)(A)(ii), if an item or service does not require an authorization to get benefits, the plan cannot deny coverage after the person receives it based on a lack of medical necessity. This gives everyday folks peace of mind when getting routine care that doesn't need pre-approval.
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Limits on Changing Payment Codes: Under section 1857(e)(7)(B)(iii), plans are barred from changing the billing code to reduce payment amounts after a service is provided, unless there is good cause or evidence of fraud. This stops plans from playing games with the paperwork to pay out less money.
Potential Negative Impacts for People
- The provided text does not contain any specific provisions that create negative outcomes, burdens, or consequences for individuals or groups of people in the United States.
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Tap or hover a score for the reason it gave.
- Demographic And Interest Groups
- Would retired people be better off under this? — Retirees on Medicare Advantage plans gain stronger consumer protections against post-service claim denials and payment code reductions. Would people over 65 be better off under this? — The bill directly benefits seniors enrolled in Medicare Advantage by restricting unfair claim denials and retroactive coverage changes. Would middle-income households be better off under this? — Middle-income seniors and families supporting them are protected from unexpected medical bills due to retroactive coverage denials.
- Healthcare
- Does this make health care easier to get in general? — By prohibiting retroactive denials of medically necessary care after approval, the bill ensures patients can receive treatment with greater confidence. Does this put more money into Medicare, the health coverage for people over 65? — The legislation establishes new restrictions on Medicare Advantage plans regarding prior authorization and claims denials.
- Economy And Finance
- Does this give people more protection from unfair business practices? — The bill protects Medicare Advantage enrollees by preventing insurers from denying coverage for approved or un-prior-authorized care based on medical necessity.
- 10/22/2026
- 1 Cosponsor added.
- 10/5/2026
- 1 Cosponsor added.
- 10/1/2026
- 1 Cosponsor added.
- 9/24/2026
- 1 Cosponsor added.
- 9/15/2026
- Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 1 Cosponsor added.
- Introduced in House
Maggie GoodlanderDemocrat · New Hampshire
Mariannette Miller-MeeksRepublican · Iowa
Robert OnderRepublican · Missouri
Eric SorensenDemocrat · Illinois
Joe WilsonRepublican · South Carolina