The Save MEDICARE Act of 2026 reforms Medicare Advantage by tightening payment accuracy, enhancing audit and enforcement authority, and requiring private insurers to reimburse the VA for veteran healthcare services.
Lloyd Doggett
Representative
TX-37
The Save MEDICARE Act of 2026 aims to increase transparency and accountability within the Medicare Advantage program by reforming payment methodologies, tightening oversight of diagnosis coding, and accelerating audit processes. The bill also enhances the Department of Veterans Affairs' ability to recover healthcare costs from private insurers and empowers states to enforce federal requirements for Medicare Advantage plans. These measures are designed to ensure more accurate payments, reduce deceptive practices, and protect resources for all Medicare enrollees.
Save MEDICARE Act Overhauls Medicare Advantage Payments and Veterans’ Care Reimbursement for 2028.
The Save MEDICARE Act of 2026 is a major legislative push to tighten the belt on Medicare Advantage (MA) plans and change how the government pays private insurers. Starting in 2028, the bill fundamentally shifts the math behind your coverage, targeting 'upcoding'—where insurers might list extra diagnoses to get higher payments from the government—and requiring these private plans to finally pay the VA back when they treat veterans. It’s essentially a massive audit and accounting reset designed to ensure that the billions flowing into private Medicare plans actually match the care being delivered.
Cracking the Code on Payments
For years, Medicare Advantage plans have used 'chart reviews' and 'health risk assessments' to identify patient illnesses and boost their government checks. This bill puts a hard stop to that in 2028 (Section 2). If a diagnosis only shows up in a plan’s own paperwork and not in a doctor’s actual treatment notes, it won’t count toward the payment calculation anymore. Think of it like a tax audit where you can’t claim a deduction without a store receipt; the government is demanding proof of treatment before they pay out. For the average person, this might mean your insurer becomes much more focused on making sure you actually see a doctor for your chronic conditions rather than just sending a nurse to your house for a yearly 'assessment' that doesn't lead to treatment.
The VA Gets Its Tab Settled
One of the biggest shifts in this bill is for veterans. Currently, if a veteran is enrolled in a private Medicare Advantage plan but goes to a VA hospital for care, the private plan often doesn't foot the bill. Section 6 changes the game by requiring these insurers to reimburse the VA for everything from ER visits to medical devices. It also sets a strict 45-day deadline for insurance companies to pay 'clean claims' to the VA or face massive penalties—up to $50,000 per violation. For a veteran, this could mean less red tape and better-funded VA facilities, as private insurance money finally starts flowing into the VA system for the care they provide.
New Rules for the Insurers
The bill also hands more power back to the states and changes how doctors are paid. Section 7 gives state regulators the green light to enforce federal Medicare rules themselves, which could mean a more local 'cop on the beat' if you have an issue with your plan. Additionally, the bill bans 'percentage-of-premium' contracts (Section 8), which are deals where doctors get a cut of the insurance premium. The goal is to make sure your doctor is motivated by your health, not by how much money the insurance company is making. However, there is a catch: Section 5 removes the right to 'judicial review' for certain audit results. This means if the government decides an insurance company owes money back due to an audit, the company can’t take it to a traditional court to argue their case, which is a significant shift in how these disputes are handled.