Stop Deadly Denials Act of 2026

Key Points

• Starting January 1, 2027, Medicare Advantage plans would no longer be allowed to require prior authorization for most medical services. This means insurance companies could not force doctors to get permission before providing treatments to seniors.
• The ban on prior authorization covers most medical services but does not apply to prescription drugs covered under Part D or supplemental benefits like gym memberships or dental plans that go beyond standard Medicare coverage.
• The bill blocks a specific government program called the WISeR Model that would have tested prior authorization requirements in traditional Medicare. It also bars any future similar models from being tested.
• Future Medicare innovation models that include prior authorization cannot use artificial intelligence or algorithms to deny coverage without a human doctor individually reviewing and approving each denial based on their own medical judgment.
• Medicare Advantage plans that violate the prior authorization ban would face government sanctions. The bill also requires that all future Medicare innovation models go through a public notice-and-comment period before they can be adopted.

Votes

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Related Bills

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