Save MEDICARE Act of 2026
Sponsored By: Representative Doggett, Lloyd [D-TX-37]
Introduced
Summary
Tighter oversight of Medicare Advantage payments. This bill rewrites how diagnoses, audits, benchmarks, and penalties work for Medicare Advantage and related drug plans to curb improper payments and boost enforcement.
Show full summary
- Seniors and Medicare Advantage enrollees: Changes which diagnosis codes count for risk-adjusted payments and excludes diagnoses found only through chart reviews and health risk assessments starting with 2028 rulemaking. It also extends the Medicare Advantage Quality Bonus Program through 2028 and bans provider coding incentive contracts for plan years beginning January 1, 2028.
- Veterans and the VA: Creates clear authority for the Department of Veterans Affairs to recover Medicare-covered care costs from Medicare Advantage organizations and prescription drug plan sponsors and directs recovered amounts into the VA Medical Care Collections Fund. It also expands VA subrogation and recovery procedures for non-service-connected care.
- Plans, providers, and regulators: Tightens Risk Adjustment Data Validation audit timing, allows extrapolation of audit results, funds audits via a 0.02% reduction in MA payments, and permits recovery-audit contracts with contingency fees up to 20%. The bill also creates strong civil penalties and requires states and CMS to coordinate Part C enforcement.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 0 benefits, 0 costs, 4 mixed.
New Medicare Advantage payment formula
If enacted, the bill would replace the old county-quartile benchmark system and use a new base payment for each area starting with 2028. The Secretary would multiply an area's base payment by a "selection percentage" (using 2025 as the baseline) to set a selection-adjusted base payment each year. The bill would also require CMS to adjust base payments for the phase-out of indirect medical education and to exclude kidney organ-acquisition costs back to 2021. These changes would change plan benchmarks and could raise or lower Medicare Advantage plan payments, which can affect premiums and benefits.
VA recovery from Medicare Advantage plans
If enacted, the bill would let the VA recover reasonable charges from third parties and require MA plans and drug plans to reimburse the VA for covered care to enrolled beneficiaries for plan years starting January 1, 2028. Third parties would have to send recipient identity info within 30 days and pay or provide claim info within 45 days. Interest would start after 45 days and penalties could apply after a 30-day notice. Reimbursements would go into the VA Medical Care Collections Fund and the bill sets general time limits for actions (typically 6 years, and 3 years for tort suits).
Tighter Medicare Advantage audit and coding rules
If enacted, the bill would bar CMS from using diagnoses found only by chart reviews or health risk assessments in Part C and Part D risk adjustments starting with payments for 2028. It would ban provider contracts that pay a percent of plan premium or other coding-linked bonuses for plan years starting January 1, 2028. The bill would speed up RADV audit and appeal deadlines, let CMS extrapolate audit findings, and bar judicial review. CMS payments would be cut by 0.02% to fund RADV audits, and the government could hire recovery-audit contractors that may get up to 20% of recouped overpayments while imposing penalties equal to overpayments plus interest.
State enforcement of Medicare Advantage rules
If enacted, the bill would let States require Medicare Advantage organizations that operate in the State to meet Part C rules. The Secretary would have to coordinate enforcement with the State where a plan is licensed and any State where plans are sold or offered. CMS could enter formal collaborative enforcement agreements with States. This could increase state-level oversight and beneficiary protections while raising compliance work for plans.
Sponsors & CoSponsors
Sponsor
Doggett, Lloyd [D-TX-37]
TX • D
Cosponsors
Rep. Ansari, Yassamin [D-AZ-3]
AZ • D
Sponsored 6/30/2026
Rep. Balint, Becca [D-VT-At Large]
VT • D
Sponsored 6/30/2026
Rep. Casar, Greg [D-TX-35]
TX • D
Sponsored 6/30/2026
Rep. Chu, Judy [D-CA-28]
CA • D
Sponsored 6/30/2026
Rep. Clarke, Yvette D. [D-NY-9]
NY • D
Sponsored 6/30/2026
Rep. Cleaver, Emanuel [D-MO-5]
MO • D
Sponsored 6/30/2026
Rep. Cohen, Steve [D-TN-9]
TN • D
Sponsored 6/30/2026
Rep. Davis, Danny K. [D-IL-7]
IL • D
Sponsored 6/30/2026
Rep. DeLauro, Rosa L. [D-CT-3]
CT • D
Sponsored 6/30/2026
Rep. Deluzio, Christopher R. [D-PA-17]
PA • D
Sponsored 6/30/2026
Rep. Dingell, Debbie [D-MI-6]
MI • D
Sponsored 6/30/2026
Rep. Garamendi, John [D-CA-8]
CA • D
Sponsored 6/30/2026
Rep. García, Jesús G. "Chuy" [D-IL-4]
IL • D
Sponsored 6/30/2026
Rep. Garcia, Robert [D-CA-42]
CA • D
Sponsored 6/30/2026
Rep. Grijalva, Adelita S. [D-AZ-7]
AZ • D
Sponsored 6/30/2026
Rep. Huffman, Jared [D-CA-2]
CA • D
Sponsored 6/30/2026
Rep. Jackson, Jonathan L. [D-IL-1]
IL • D
Sponsored 6/30/2026
Rep. Jayapal, Pramila [D-WA-7]
WA • D
Sponsored 6/30/2026
Rep. Johnson, Henry C. "Hank" [D-GA-4]
GA • D
Sponsored 6/30/2026
Rep. Khanna, Ro [D-CA-17]
CA • D
Sponsored 6/30/2026
Rep. Mfume, Kweisi [D-MD-7]
MD • D
Sponsored 6/30/2026
Rep. Nadler, Jerrold [D-NY-12]
NY • D
Sponsored 6/30/2026
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 6/30/2026
Rep. Ocasio-Cortez, Alexandria [D-NY-14]
NY • D
Sponsored 6/30/2026
Rep. Omar, Ilhan [D-MN-5]
MN • D
Sponsored 6/30/2026
Rep. Pingree, Chellie [D-ME-1]
ME • D
Sponsored 6/30/2026
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 6/30/2026
Rep. Randall, Emily [D-WA-6]
WA • D
Sponsored 6/30/2026
Rep. Schakowsky, Janice D. [D-IL-9]
IL • D
Sponsored 6/30/2026
Rep. Scott, Robert C. "Bobby" [D-VA-3]
VA • D
Sponsored 6/30/2026
Rep. Smith, Adam [D-WA-9]
WA • D
Sponsored 6/30/2026
Rep. Takano, Mark [D-CA-39]
CA • D
Sponsored 6/30/2026
Rep. Thanedar, Shri [D-MI-13]
MI • D
Sponsored 6/30/2026
Rep. Thompson, Bennie G. [D-MS-2]
MS • D
Sponsored 6/30/2026
Rep. Tlaib, Rashida [D-MI-12]
MI • D
Sponsored 6/30/2026
Rep. Velázquez, Nydia M. [D-NY-7]
NY • D
Sponsored 6/30/2026
Rep. Waters, Maxine [D-CA-43]
CA • D
Sponsored 6/30/2026
Rep. Watson Coleman, Bonnie [D-NJ-12]
NJ • D
Sponsored 6/30/2026
Rep. Green, Al [D-TX-9]
TX • D
Sponsored 6/30/2026
Rep. Carson, André [D-IN-7]
IN • D
Sponsored 6/30/2026
Rep. McGovern, James P. [D-MA-2]
MA • D
Sponsored 6/30/2026
Rep. Tokuda, Jill N. [D-HI-2]
HI • D
Sponsored 6/30/2026
Rep. DeSaulnier, Mark [D-CA-10]
CA • D
Sponsored 6/30/2026
Rep. Krishnamoorthi, Raja [D-IL-8]
IL • D
Sponsored 7/2/2026
Rep. Menefee, Christian D. [D-TX-18]
TX • D
Sponsored 7/2/2026
Rep. Ramirez, Delia C. [D-IL-3]
IL • D
Sponsored 7/2/2026
Rep. Latimer, George [D-NY-16]
NY • D
Sponsored 7/6/2026
Rep. Williams, Nikema [D-GA-5]
GA • D
Sponsored 7/6/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov