HB 1639
In CommitteeHouse
Medicare advantage discl.
Requiring entities offering medicare advantage coverage in Washington to provide certain disclosures to consumers.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill requires Medicare Advantage plan providers in Washington to share key information with consumers — including how often they deny claims, how many denials are reversed on appeal, and how to appeal — before and after enrollment. It also makes failing to comply with these rules a violation of the state’s Consumer Protection Act.
- Requires Medicare Advantage plan providers to disclose their claims denial rate as a percentage to current and potential enrollees.
- Requires providers to disclose the percentage of denied claims that are overturned on appeal.
- Requires providers to explain the appeal process for denied coverage decisions.
- Disclosures must be made before enrollment and again upon request after enrollment.
- Declares violations of these disclosure rules to be unfair or deceptive practices under Washington’s Consumer Protection Act (chapter 19.86 RCW).
Who is affected
- Medicare Advantage enrollees and potential enrollees — People enrolled in or considering Medicare Advantage plans in Washington will receive clearer information about how often claims are denied, how many denials are overturned on appeal, and how to appeal — helping them make more informed choices about their health coverage.
- Medicare Advantage plan sponsors and insurers — Insurance companies and other organizations that sell Medicare Advantage plans in Washington must now provide specific data and appeal instructions to consumers, and must comply with state consumer protection laws if they fail to do so.
- Washington state government agencies (e.g., Office of the Attorney General, Department of Insurance) — State regulators and the attorney general may enforce this law under the Consumer Protection Act, giving them new authority to address unfair or deceptive practices by Medicare Advantage plans.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (4)
Mandates pre-enrollment and post-enrollment disclosures, strengthening consumer autonomy and reducing information asymmetry — particularly valuable for low-income seniors, non-English speakers, and those with limited health literacy who may otherwise rely on opaque marketing materials.
HealthcarePeopleRef: Sec. 1(2); Sec. 2Designates noncompliance as an unfair or deceptive practice under Washington’s Consumer Protection Act, empowering the Attorney General to pursue enforcement — giving individual enrollees indirect protection through systemic deterrence, even if they lack resources to sue individually.
Rights & LibertiesPeopleRef: Sec. 2Requires clear explanation of the appeal process — which may reduce administrative barriers to accessing covered care, especially for enrollees who have previously been denied benefits without knowing how to challenge the decision.
HealthcarePeopleRef: Sec. 1(1)(c)Minimal fiscal impact on state agencies — no new spending required — meaning the cost of enforcement (e.g., monitoring, investigations) is expected to be absorbed within existing resources, avoiding new tax burdens on Washington households.
Local GovernmentLean peopleRef: Fiscal Impact section
Potential Concerns (1)
Requires Medicare Advantage plan providers to disclose claims denial rates, appeal reversal rates, and appeal processes — improving transparency and enabling enrollees to make more informed coverage decisions, especially for vulnerable seniors with complex health needs.
HealthcarePeopleRef: Sec. 1(1)(a)-(c); Sec. 2
Who Is Most Affected
Medicare Advantage enrollees — especially low-income seniors, people with disabilities, and those with chronic conditions — benefit significantly from increased transparency, as they can better assess plan reliability and navigate denials. This group is disproportionately affected by opaque coverage decisions and has limited alternatives if they’re enrolled in a plan with high denial rates.
Medicare Advantage insurers face compliance costs (e.g., data tracking, disclosure formatting, legal risk exposure), but these are modest relative to their revenue and may be offset by reduced appeals litigation or improved trust. Large national insurers (e.g., UnitedHealth, Humana) bear most of the burden; small regional plans may face proportionally higher relative costs.
State agencies (e.g., Attorney General’s Office, Insurance Commissioner) gain new enforcement authority under the Consumer Protection Act, but the fiscal impact is projected to be minimal. This enhances state oversight capacity without requiring new appropriations.
Medicare Supplement (Medigap) insurers and traditional Medicare providers are not directly affected, but may see indirect effects if enrollees shift away from high-denial-rate Advantage plans — potentially increasing demand for alternative coverage.
Community health centers and legal aid organizations may see reduced demand for assistance with plan denials and appeals, as enrollees have clearer pathways to challenge decisions — though this is speculative and not guaranteed.