Actually, original medicare has for quite some time had some prior authorization requirements. In fact, the denial rate is about 2.8x higher than it is for the advantage plans with the highest rate of denials. The reason that is not more visible is that OM has a very low rate of prior authorization requests, per capita.In the next 5 to 10 years original medicare may be vey well be managed care just like MA. It has already started in some states.
Sure, that may be true this year. Next year or 20 years out, your Advantage options may be very disappointing. They change every year.
https://www.kiplinger.com/retirement/me ... l-medicare
Prior authorization implemented well can function as quality control for care. Implemented inauspiciously, it can be a barrier to quality care. I think original medicare actually would benefit from a little more use of prior authorizations to identify medically unnecessary care before it is administered.
Statistics: Posted by Northern Flicker — Wed Nov 26, 2025 1:16 am — Replies 53 — Views 2790