Medicare Advantage Prompt Pay Act

Key Points

• This bill requires Medicare Advantage insurance companies to pay at least 95% of clean claims within strict deadlines — 14 days for electronic in-network claims and 30 days for all others — ensuring doctors and hospitals get paid faster.
• If an insurance company misses the payment deadline, it must pay interest to the doctor or hospital at a rate set by federal law, creating a financial penalty for slow payments.
• The government can fine Medicare Advantage companies up to $25,000 each time they violate the prompt payment rules, giving enforcement real teeth.
• Medicare Advantage plans would have to publicly report how many claims they paid, how many were paid on time, and how much interest they owed for late payments — making it easy for people to compare plans.
• These new rules take effect for services provided on or after January 1, 2027, giving insurance companies and health care providers time to prepare.