Traditional Medicare: Prior Authorization Might Be Headed Your Way

August 30, 2025 — Prior authorization is one of the biggest dissatisfactions with health insurance plans. It entails getting approval for certain kinds of procedures or treatments, before they can happen, and is an unpopular part of most HMO and Medicare Advantage plans. While the policy saves money for insurance companies and guards against unnecessary medical expenses, it is viewed as both a hassle and a barrier to important medical care. Delays caused by the approval process can also have serious consequences.

Traditional Medicare is stepping into a game with a test program using Artificial Intelligence (AI).  The pilot, using private contractors, would start in six states next year. It will concentrate on on a list of procedures that Medicare believes are too costly with little to no benefit to patients. Spine surgeries and steroid injections seem to be some of the procedures that will be on that list.

What is upsetting to many people is that the reason why the selected Traditional Medicare (Part B) over a Medicare Advantage Plan (Part C) is that didn’t want to have to risk prior approval. And they paid higher premiums to get that privilege (many Medicare Advantage plans carry zero premiums and provide extra benefits like vision and dental coverage).

See the full article in the New York Times – Medicare Will Require Prior Approval for Many Procedures.