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LaurieM808259
Contributor ⭐
August 29, 2025

Medicare Prior Approval Pilot Program?

  • August 29, 2025
  • 3 replies
  • 1431 views

What is AARP's position on Medicare's soon to be enacted pilot program in six states that would require prior approval for certain medical procedures? 

    3 replies

    K
    KenD491217
    Contributor ⭐
    August 29, 2025

    Thanks for posting this. I'm very troubled by this proposal and also would like know AARP's position. 

      SereneSeagull
      SereneSeagull
      Community Champion ⭐⭐⭐
      August 29, 2025

      I believe if it’s what I read, AI driven for determining 

      C
      CBtoo
      Conversationalist ⭐⭐
      August 29, 2025

      Yes that is correct and it is for 6 years. The list though of what will require prior authorization at this point in time is pretty short. 

      If you care to grit your teeth (as I know some of chose original medicare rather than an advantage plan because we didn't have to deal with referrals and prior authorizations for most things)

      https://www.cms.gov/priorities/innovation/innovation-models/wiser

       

      https://www.cms.gov/files/document/wiser-fact-sheet.pdf

       

      Affected Services
      The following 17 services will require prior authorization under the WISeR Model: 
       

      https://www.resourcemedicare.com/post/new-medicare-changes-in-2026-prior-approval-required-for-these-17-services

       

      These are the states involved: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington

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