Bill · H.R. 10394· House(119-HR-10394)
Protecting Approved Care Act
- Introduced
- 9/15/2026
- Last activity
- 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.
- Sponsored by
- Greg Landsman
- Cosponsors
- - 1 - 3
- 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
Would people over 65 be better off under this?+7
The bill directly benefits seniors enrolled in Medicare Advantage by restricting unfair claim denials and retroactive coverage changes.
Would retired people be better off under this?+7
Retirees on Medicare Advantage plans gain stronger consumer protections against post-service claim denials and payment code reductions.
Does this give people more protection from unfair business practices?+6
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. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Retirees+7Good For Seniors+7Good For Middle Class Households+4
- Healthcare
- Improves Healthcare Access+5Increases Medicare Funding+4
- Economy And Finance
- Improves Consumer Protection+6
- 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
Joe WilsonRepublican · South Carolina