New Medicare Advantage Rule Ends Surprise Bills from Phantom Doctors, Starting 2028

The REAL Health Providers Act is stepping in to fix one of the most frustrating problems in healthcare: the phantom doctor listed in your insurance directory. This bill targets Medicare Advantage (MA) plans—specifically network-based plans—and mandates that starting in 2028, these plans must keep their online provider directories accurate, checking every single entry at least every 90 days. If a doctor leaves the network, the plan has just five business days to remove them from the public list. This is a massive administrative shift aimed squarely at improving patient experience and network transparency.

The Cost-Sharing Shield: No More Surprise Bills

For anyone who has ever shown up to a specialist appointment only to find out they are not in-network despite what the website said, this is the biggest win. Starting in 2028, if you rely on the MA plan’s directory to choose a doctor who is listed as in-network, but they turn out to be out-of-network when you receive care, the plan must treat your visit as if the doctor were in-network. This means you won’t get stuck with higher out-of-network costs. The MA plan organization must absorb the difference, effectively protecting the patient from financial penalties due to the plan’s poor data management. This provision is a game-changer for consumer protection in the MA space.

The Quarterly Check-Up: Keeping Directories Honest

The bill requires MA organizations to include crucial details in their directories, like whether a provider is taking new patients, if they offer telehealth, and what languages they speak. But the real teeth of the law is the 90-day verification requirement (Section 2). Imagine an MA plan covering thousands of doctors; that means checking the status of every single one, four times a year. This is a huge administrative lift for the plans and for providers, who will likely face a constant stream of verification requests. The bill specifically calls out mental health and substance use disorder providers for targeted accuracy checks, acknowledging that these specialties often have the highest error rates in existing directories.

Public Report Cards and Transparency

Starting in 2029, these MA plans won't just have to report their directory accuracy; they’ll have to post an annual accuracy score right on their public directory. Think of it as a Yelp review for their administrative competence, determined by the government. The Secretary will set the exact math for this score, but the goal is to give beneficiaries a clear, simple metric to compare plans. This public shaming/incentive structure is designed to drive compliance, as no plan wants a low score splashed across their main enrollment page. To get this oversight off the ground, the bill sets aside $4 million for CMS to manage these new duties (Section 2).

The Trade-Off: Efficiency vs. Paperwork

While patients are the clear winners here, the cost falls on the MA organizations and, indirectly, the providers. The administrative burden of quarterly verification and annual reporting is significant. This bill requires the Secretary to hold a public meeting to figure out how to standardize data and cut down on paperwork, which is a necessary step. If the new rules just create endless, redundant paperwork for doctors and hospitals, that time and cost will eventually get passed on. The Government Accountability Office (GAO) is tasked with studying the rollout through 2032, looking specifically at how often patients used the cost-sharing protection and how much administrative work this created. The success of this law hinges on whether the government can make the verification process efficient without losing the necessary accuracy.