Lawmakers Urge CMS to Streamline Prior Authorization

Key Takeaways

• Original Medicare has minimal prior authorization requirements, while Medicare Advantage plans require approval for nearly all services—understand this key difference when choosing your plan
• Proposed 2025 rules will prevent Medicare Advantage carriers from denying services that Original Medicare covers, providing stronger protections for beneficiaries
• Demand a prior authorization decision within 24 hours under new rules to avoid being stuck in limbo waiting to learn if your doctor-recommended service will be covered
• Request detailed billing statements showing which services were billed, what Medicare paid, and where your benefits went—transparency metrics are improving but you may need to ask
• Prior authorizations won't disappear due to ongoing fiscal pressures on Medicare as 65+ population grows, so expect this to remain a factor in healthcare decisions