Medicare Prior Authorization Reformed by HHS and Insurers to Speed Care

Patients on Medicare and other health insurance plans may be able to get colonoscopies, cataract surgeries, and other major medical services more quickly starting as early as next year.

The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) recently announced an agreement with major insurers — UnitedHealthcare, Cigna, Humana, Aetna, Blue Cross Blue Shield, and Kaiser Permanente — to simplify or eliminate prior authorization procedures.

Prior authorization is the process where health insurers review and decide whether to approve tests or treatments recommended by a patient’s doctor. Until now, delays or denials from insurers often made it difficult for patients to receive timely care, even with doctor approval.

Under the agreement, these insurers will take steps to simplify paperwork, speed up medical decisions, and increase transparency for patients and providers.

Insurers plan to reduce the list of medical services requiring prior authorization by January 1, 2026, and to convert 80% of all prior authorizations to real-time approvals by January 1, 2027.

KFF Health News, a nonprofit health media outlet, reported that prior authorization requirements may be eased or removed for common services such as knee arthroscopy, childbirth, colonoscopy, and cataract surgery.

Additionally, patients already undergoing treatment will likely be able to continue their existing care without prior authorization restrictions for 90 days if they switch health insurers.

BY HYOUNGJAE KIM [kim.ian@koreadaily.com]