Private Medicare Advantage (MA) plans are allowed under the law to employ utilization management techniques in order to control spending and ensure that plan enrollees receive medically necessary care. Prior authorization, or pre-approval, for coverage of items and services is widespread within the MA program. Virtually all MA enrollees are required to obtain prior authorization for some services. In response to growing attention to problems posed by prior authorization, the Centers for Medicare & Medicaid Services (CMS) issued a rule for 2024 aimed at limiting MA plans’ ability to inappropriately deny care. While this rule has somewhat narrowed MA plans’ ability to overutilize prior authorization, there remain significant gaps to fill with respect to consumer protections. One issue that continues to negatively impact MA enrollees is when care is initially authorized by the plan but terminated before it is clinically appropriate to do so.
- Download the full Brief at medicareadvocacy.org/wp-content/uploads/2026/04/2026-04-02-IB-MA-Terminations-AV.pdf
April 2, 2026 – D. Lipschutz