Proposed Rule Would Improve Medicare Advantage Prior Authorization and Transparency

This week, Medicare Rights submitted comments in response to the annual Medicare Advantage (MA) and Part D proposed rule for 2026 from the Centers for Medicare & Medicaid Services (CMS). Among the highlights in the proposed rule are provisions that would improve Medicare Advantage prior authorization standards and require new transparency and avenues for potential enrollees to understand their care options. We enthusiastically support these proposals and urge the new Trump administration to finalize them.

We enthusiastically support these proposals and urge the new Trump administration to finalize them.

Potential to Protect Against Overuse of Prior Authorizations

One of the most impactful of the proposals would strengthen limitations on plans’ internal coverage rules for prior authorization, requiring evidence that the rules have some clinical benefit and are not just attempts to delay or deny care. CMS would require plans to be more transparent about how they use these internal rules, including making them easier for enrollees and the public to access, and reiterates the prohibition on using any rule that automatically denies coverage. This includes using artificial intelligence or other mechanisms that do blanket denials.

Provider Directories Would be Incorporated Into Plan Finder

Other proposals would require plans to submit accurate and up-to-date provider directory data to CMS so that the information can be used with Medicare Plan Finder. This would allow people to find plans where their preferred providers are in network and increase ease and transparency for the public to gauge plans’ network adequacy. Currently, potential enrollees must go to each plan’s website for this information, and the directories are often outdated and filled with inaccurate information.

Intentions for More Transparent Marketing

The rule would also do more to curtail inappropriate marketing, including through greater oversight of MA materials and banning plans from marketing debit cards as a benefit.

Related to marketing, the rule would also require agents and brokers to inform consumers about affordability programs like the Low-Income Subsidy (LIS or “Extra Help”) for drug costs and Medicare Savings Programs (MSP) for other Medicare costs. In addition, brokers would be required to tell people who are contemplating switching from Original Medicare to MA about the effect that would have on their future Medigap eligibility.

Anti-Obesity Medications Under Scrutiny

One of the more controversial proposals would open up coverage in Part D for anti-obesity medications. While Medicare Rights supports extending Medicare coverage where possible, we did urge CMS to ensure that this coverage decision is coupled with aggressive actions to limit the costs of these drugs and the runaway profits of the manufacturers. Importantly, some of these drugs are up for drug price negotiation in the second round, which gives hope for some reduction in their cost.

Medicare Rights Stands Firm Amidst Changing Administration

These proposals show important avenues for improvement and ways CMS could increase oversight of plans. Because this rule was proposed under the Biden-Harris administration and would be finalized under the Trump administration, it is probable that many of these proposals will not be adopted. But no matter the administration, we will continue our work to improve MA and Part D and protect the health, financial stability, and well-being of current and future beneficiaries.

Further Reading

Read the proposed rule and our comments.

Read more about prior authorization.

Read more about Medigap access.