Better Medicare Alliance Unveils 10-Point Policy Roadmap to Protect Medicare Advantage Affordability, Choice and Stability
Agenda calls for faster prior authorization decisions, stronger oversight of in-home health risk assessments, a next-generation risk model and greater stability for more than 35 million beneficiaries
WASHINGTON — Better Medicare Alliance (BMA) today released its 2026 Medicare Advantage Policy Roadmap, a comprehensive 10-point agenda for Congress and the Centers for Medicare & Medicaid Services (CMS) to strengthen Medicare Advantage while protecting the affordability, choice and stability beneficiaries depend on.
More than 35 million seniors and people with disabilities—over half of the Medicare population—now choose Medicare Advantage. But recent policy changes have contributed to growing disruption across the program. In 2025 alone, nearly 3 million beneficiaries had to select new coverage after their plans exited markets or closed, while beneficiaries have also faced higher out-of-pocket costs and reductions in supplemental benefits.
BMA’s roadmap offers a path forward: practical reforms that improve beneficiaries’ access to care, strengthen transparency and accountability, and give health plans and providers the predictability needed to make long-term investments in better health outcomes.
“More than half of Medicare beneficiaries now choose Medicare Advantage, and public policy must reflect the program’s central role in American health care,” said Mary Beth Donahue, President and CEO of Better Medicare Alliance. “Our roadmap sets out a clear path to protect seniors from disruption while making Medicare Advantage more transparent, accountable and responsive to their needs. These are actionable reforms that Congress and CMS can begin advancing now.”
The roadmap’s 10 policy priorities are:
- Streamline prior authorization by reducing the deadline for expedited decisions from 72 to 24 hours, advancing real-time decisions for routinely approved care and ensuring that no adverse determination is made solely by artificial intelligence without review by a licensed clinician.
- Advance next-generation risk adjustment through a carefully tested transition toward an encounter data-calibrated model, regional impact analyses and a more predictable, multiyear update cycle.
- Expand transparency in supplemental benefits by standardizing benefit descriptions, improving the information available through Medicare Plan Finder and helping beneficiaries access and use the benefits included in their coverage.
- Modernize in-home health risk assessments by requiring clinically appropriate follow-up, stronger information-sharing with primary care providers, consistent clinical standards and targeted oversight of assessment-related diagnoses.
- Improve stability and predictability in Star Ratings by prioritizing clinical outcomes, addressing abrupt payment cliffs and protecting beneficiaries from disruption caused by sudden methodological changes.
- Promote program integrity through risk-based enforcement, stronger provider validation and better real-time data-sharing among CMS, health plans and other program-integrity partners.
- Protect beneficiaries from deceptive marketing by strengthening oversight of third-party marketing organizations, prohibiting the resale of beneficiary information and developing performance measures that reward high-quality enrollment assistance.
- Strengthen provider-network accuracy through standardized data, independent audits and progress toward an interoperable national provider directory.
- Improve alignment between Medicare Advantage and Department of Veterans Affairs payments by establishing data-sharing infrastructure and accounting appropriately for VA-provided care in Medicare Advantage benchmarks.
- Support value-based care by preserving the flexibility and policy stability health plans and providers need to build arrangements tailored to particular patients, conditions and communities.The roadmap also identifies seven legislative priorities and sets out four principles for implementing new requirements without creating duplicative reporting systems or unnecessary administrative burden.
“Continued efforts to strengthen Medicare Advantage can advance value-based, coordinated care for beneficiaries. This roadmap’s focus on thoughtful reforms that preserve stability while strengthening accountability, risk adjustment, and the partnerships between health plans and providers that make value-based care possible is especially welcome,” said Jenni Gudapati, President and CEO of HealthyInsights.ai and member of the Federal Healthcare Advisory Committee.
“Medicare Advantage Special Needs Plans serve Medicare’s highest-need beneficiaries. This solutions-oriented roadmap from Better Medicare Alliance offers a valuable opportunity to strengthen payment accuracy and risk adjustment. As policymakers consider a new risk adjustment model, it is critical to account for the unique populations Special Needs Plans serve and their limited ability to spread risk, so reforms do not unintentionally reduce access to specialized, coordinated care,” said Mike Cheek, President and CEO of SNP Alliance.
The new agenda builds on BMA’s 2023 policy recommendations while responding to changes in Medicare Advantage over the past three years. It expands BMA’s earlier work on prior authorization, in-home health assessments and supplemental benefits to address risk adjustment, Star Ratings, program integrity, marketing, provider directories, care for veterans and value-based care.
“Medicare Advantage can be made stronger without asking seniors to sacrifice the benefits or affordability they value,” Donahue added. “The goal should be reform that works for beneficiaries—not disruption that they are left to absorb.
“We look forward to working with policymakers to strengthen and protect Medicare Advantage for seniors,” Donahue said.
Read BMA’s full 2026 Medicare Advantage Policy Roadmap here.
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Better Medicare Alliance is a community of hundreds of thousands of grassroots beneficiaries and 200+ ally organizations working to improve health care through a strong Medicare Advantage. Learn more at www.bettermedicarealliance.org