Strengthening Medicare Advantage to Better Serve Today’s Seniors
Approximately 35 million Americans are enrolled in Medicare Advantage plans in 2026, and that number is expected to grow to about 45 million MA enrollees by 2030. That means within the next four years, more than 10% of our nation’s population will depend on MA insurance to cover their health care needs and those of their families.
When people choose an MA plan, they count on it to provide the agreed-upon coverage for current medical needs and those that may arise. While some MA plans fulfill their responsibility to promote strong patient care and access, others often do not. These plans include several of the country’s largest commercial insurers covering millions of Medicare enrollees.
The AHA has long advocated for strengthening federal oversight of MA programs to ensure beneficiary access to care, program integrity and the financial stability of Medicare overall. Just last week, the AHA expressed support for the Medicare Advantage Improvement Act, bipartisan and bicameral legislation that offers comprehensive reforms to address harmful MA plan practices that reduce access to necessary care and delay or deny payments to providers.
The bill builds upon many of the policies that hospitals and health systems have long supported to hold commercial insurers accountable. We continue to hear increasing concerns from clinicians and patients about MA plan practices that can delay or deny care, create confusion, and add unnecessary cost and burden to the health care system. These challenges are most visible in the growing use of prior authorization — a tool intended to ensure appropriate care, but one that is too often misused in ways that slow access to needed treatment.
The bill addresses these prior authorization concerns by requiring standard approvals within 72 hours, expedited decisions within 24 hours and real-time approvals for routine low-risk services integrated with electronic health records. It also remedies some of the specific challenges post-acute care providers face with MA plans by taking steps to ensure network requirements include access to long-term care hospitals and inpatient rehabilitation facilities.
In addition, the bill recognizes there are no existing prompt payment standards that require MA plans to provide timely payment to contracted providers. This contributes to the larger problem that, as found in an AHA survey, 50% of hospitals and health systems reported having more than $100 million in unpaid claims that were more than six months old. These payment delays prevent hospitals from investing in patient care and exacerbate the current financial challenges facing many hospitals. The bill would require all qualifying claims for authorized items and services to be deemed as clean claims and paid consistent with Original Medicare’s prompt payment timelines.
The Medicare Advantage Improvement Act reflects a shared understanding that reforms are needed to better align the program with its core mission. Hospitals and health systems stand ready to work with policymakers and other stakeholders to strengthen MA to ensure that the program works for the millions of seniors who rely on it.