Medicare Advantage prior authorization rules tightened

What does this do?

This bill sets new rules for Medicare Advantage plans around prior authorization, which is when a plan must approve a treatment, test, or medication before a patient can get it. Beginning in 2027, plans must report yearly data to the federal government — such as approval and denial rates, decision times, and how often AI was used — and that data must be posted online. Starting in 2028, plans must use secure electronic systems for these requests, regularly review which services still need prior authorization, and allow high-performing doctors to skip some requirements.

Who does it affect?

Seniors and people with disabilities enrolled in Medicare Advantage plans are most directly affected. Doctors, hospitals, and other health care providers who treat those patients are also affected.

Why does it matter?

More detailed public data could make it easier to see patterns in how plans approve or deny care. Faster electronic systems and tighter response time limits could change how quickly patients and doctors get decisions on care requests.

Where does it stand?