This bill fixes a major problem with Medicare Advantage plans: their doctor and provider directories are often outdated and inaccurate, leaving seniors confused about which doctors are actually in their network. Starting in 2026, Medicare Advantage plans will be required to maintain accurate, publicly available lists of all their network providers and update this information at least every 90 days. If a plan can't verify that a provider is still in the network, they have to clearly mark that information as potentially outdated. Plans must also remove providers from their directory within 5 business days once they're no longer part of the network.

The bill also protects patients from surprise bills. If you go to a doctor who's listed in your plan's directory but turns out not to be in the network, you'll only pay the in-network cost-sharing amount instead of higher out-of-network fees. Plans must notify you about this protection and include it in their provider directory and billing statements. Additionally, Medicare Advantage organizations will have to analyze how accurate their provider directories are each year and report their findings to the government, with special attention paid to hard-to-find specialists like mental health and substance abuse treatment providers. These accuracy scores will be publicly posted so you can see which plans maintain better directories when choosing your coverage.

To make sure this works, the government is funding oversight activities and will study how well these changes protect patients over the next five years, with a report due to Congress by 2031.

REAL Health Providers Act

Bennet, Michael F.

Requiring Enhanced &amp; Accurate Lists of Health Providers Act or the REAL Health Providers ActThis bill requires Medicare Advantage (MA) organizations to maintain directories of in-network providers and continually ensure their accuracy.Specifically, MA organizations must publish on their websites an accurate directory of in-network providers and regularly update these directories. The bill additionally specifies that if a provider is listed as in-network in this directory when a beneficiary selects and makes an appointment with the provider, but the provider is not actually in-network, the beneficiary is still only responsible for paying in-network cost-sharing requirements.MA organizations must annually evaluate and report on the accuracy of their directories; the Centers for Medicare &amp; Medicaid Services and MA organizations must publish this information on their websites. The bill provides funds for these purposes.The Government Accountability Office must report on the bill's implementation.