Save MEDICARE Act of 2026

Key Points

• Starting in 2028, the government will stop counting certain diagnosis codes from chart reviews and health risk assessments when calculating how much to pay private Medicare Advantage insurers, cracking down on a common way plans have inflated payments.
• The bill ends the Medicare Advantage quality bonus program after 2028, removing a payment boost that critics say has been paid out too generously regardless of actual plan performance.
• When a veteran enrolled in Medicare Advantage or a Medicare drug plan gets care at a VA facility, the private insurer must now reimburse the VA for that care, ending a longstanding gap where insurers avoided paying for covered services.
• The government will speed up fraud audits, requiring contract-level reviews within one year and medical record reviews within 60 days, and will impose penalties on insurers found to have been overpaid.
• Insurance companies will be banned from paying doctors bonuses tied to a percentage of premiums or other financial incentives for adding more diagnosis codes to patient records.
• States gain new authority to enforce Medicare Advantage plan rules directly, and the bill removes the right to court appeal for CMS's overpayment audit decisions.