This bill establishes new requirements for Medicare Advantage organizations to maintain accurate, publicly available provider directories and implements cost-sharing protections for enrollees relying on incorrect listings.
Michael Bennet
Senator
CO
The REAL Health Providers Act establishes stricter requirements for Medicare Advantage (MA) organizations to maintain accurate and publicly accessible online provider directories. It mandates regular verification of provider information and protects enrollees from unexpected out-of-network costs if they rely on incorrect directory listings. Furthermore, the bill requires annual accuracy reporting and public posting of accuracy scores for MA plans.
REAL Health Providers Act Mandates 90-Day Doctor Directory Updates and Caps Costs for Ghost Networks by 2028
The REAL Health Providers Act aims to fix the 'ghost network' problem where patients pick a doctor from their insurance directory only to find out the office hasn't taken that insurance in years. Starting in 2028, Medicare Advantage (MA) plans will be legally required to verify and update their online provider directories every 90 days. If a plan can't verify a doctor's info, they have to flag it; if a doctor leaves the network, the plan has just five business days to scrub them from the list. The bill also requires directories to include practical details like whether a provider is actually accepting new patients, their telehealth options, and how they accommodate disabilities (Sec. 2).
The 'Oops, My Bad' Protection
Perhaps the most important change for your wallet is the new cost-sharing safeguard. If you're an enrollee and you book an appointment with a doctor who is listed as 'in-network' in the directory on the day of your visit, but it turns out they aren't, you won't be penalized with a massive out-of-network bill. Under Section 2, the insurance company is required to charge you the lower amount—either the standard in-network co-pay or the out-of-network rate. This effectively shifts the financial burden of a messy directory from the patient back onto the insurance company, ensuring that an insurer’s administrative error doesn't become your unexpected $500 expense.
Public Report Cards for Insurers
To keep companies honest, the bill introduces a mandatory 'accuracy score' for insurance plans. Starting in 2028, MA organizations must hire outside analysts to sample their directories—specifically looking at high-error areas like mental health and substance use disorder providers—to see how many listings are actually correct. By 2029, these accuracy scores will be posted publicly on the government’s website and right on the insurance plan’s own directory. It’s essentially a 'Yelp rating' for how much you can trust your insurer’s data, making it much harder for plans to hide thin networks behind outdated lists.
Implementation and Oversight
While this is a win for transparency, it adds a significant administrative lift for insurance providers, who will need to overhaul their data systems to meet the 90-day verification cycle. To get the ball rolling, the bill allocates $4 million for 2026 to help the Centers for Medicare & Medicaid Services (CMS) set up the rules and scoring systems. There is also a built-in 'reality check' via a GAO study due in 2033, which will look at whether these protections actually lowered costs for seniors or if insurers found new ways to navigate the regulations (Sec. 2). For now, it sets a clear standard: if an insurer advertises a doctor, they better make sure that doctor is actually in the building.