CMS plans to simplify prior authorization for Medicare beneficiaries beginning in 2026. Listen to learn more about changes coming to Medicare Advantage and Original Medicare!

 

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Resources:

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Content Library: Mastering Medicare Insurance Coverage ft. Jeff Snyder

How Storytelling Helps Agents Quickly Connect with Clients ft. Don Connelly

 

References:

“HHS Secretary Kennedy, CMS Administrator Oz Secure Industry Pledge to Fix Broken Prior Authorization System.” HHS.Gov, U.S. Department of Health and Human Services, 23 June 2025, www.hhs.gov/press-room/kennedy-oz-cms-secure-healthcare-industry-pledge-to-fix-prior-authorization-system.html. Accessed 19 Oct. 2025.

“Health Plans Are Making Voluntary Commitments to Support Patients And Providers” AHIP.Org, www.ahip.org/health-plans-are-making-voluntary-commitments-to-support-patients-and-providers. Accessed 19 Oct. 2025.

“Health Plans Take Action to Simplify Prior Authorization - AHIP.” AHIP.Org, www.ahip.org/news/press-releases/health-plans-take-action-to-simplify-prior-authorization. Accessed 19 Oct. 2025.

Ochieng, Nancy, et al. “Medicare Advantage in 2025: Premiums, out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization.” KFF, 9 Aug. 2025, www.kff.org/medicare/medicare-advantage-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization/. Accessed 19 Oct. 2025.

“Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model.” FederalRegister.Org, www.federalregister.gov/public-inspection/2025-12195/medicare-program-implementation-of-prior-authorization-for-select-services-for-the-wasteful-and. Accessed 19 Oct. 2025.

“Prior Authorization and Pre-Claim Review Initiatives.” CMS.Gov, Centers for Medicare and Medicaid Services, www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-and-pre-claim-review-initiatives. Accessed 19 Oct. 2025.

LeValley, Donna. “Prior Authorization Coming to Traditional Medicare Starting in 2026.” Kiplinger.Com, Kiplinger, 7 July 2025, www.kiplinger.com/retirement/medicare/prior-authorization-coming-to-traditional-medicare. Accessed 19 Oct. 2025.

 

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