This bill, titled the "Save MEDICARE Act of 2026," seeks to amend Title XVIII of the Social Security Act to ensure more appropriate payments under Medicare Advantage (MA) and enhance oversight. Beginning in 2028, the Secretary of Health and Human Services must analyze and exclude or adjust diagnosis codes from risk adjustment that are prone to coding variation by MA plans, particularly those with high differential coding or limited treatment implications. Furthermore, diagnoses collected solely from chart reviews or health risk assessments will no longer be considered for payment adjustments for both MA plans and Prescription Drug Plans. The legislation also modifies Medicare Advantage benchmark payments starting in 2028 by eliminating the county quartile system . It introduces an annual adjustment to the base payment amount to account for favorable selection between Medicare Advantage and original Medicare fee-for-service, utilizing a methodology developed by the Medicare Payment Advisory Commission (MedPAC). Additionally, the bill phases out the Quality Bonus Program , ending it after 2028. To improve accountability, the bill reforms the Risk Adjustment Data Validation (RADV) Program by setting strict deadlines for audits and appeals processes, effective January 1, 2028. It imposes a 0.02 percent user fee on MA organizations to fund RADV audits and grants the Secretary authority to extrapolate audit results to the broader MA population. The bill also mandates the use of recovery audit contractors to identify and recoup overpayments, including penalties, with contingency fees for contractors. A significant provision, the "Guard Veterans Health Care Act," allows the Department of Veterans Affairs (VA) to recover costs from Medicare Advantage and Prescription Drug Plans for healthcare services provided to veterans, starting in 2028. This section also strengthens the VA's existing authority to recover costs from third parties for non-service-connected disabilities, establishing clear payment deadlines, interest accrual, and civil penalties for non-compliance. Furthermore, the bill empowers states to enforce Medicare Advantage plan requirements within their jurisdictions and directs the Secretary to coordinate enforcement efforts with states. Finally, to prevent potential conflicts of interest, it prohibits Medicare Advantage organizations from using percentage of premium contracts or other financial incentives for providers that are tied to coding items and services furnished to enrollees, effective for plan years beginning on or after January 1, 2028.