Medicare Advantage (MA) plans—private insurers’ alternatives to traditional Medicare—have grown in popularity in recent years with 28 million Americans signing up. But they have one big problem that frustrates many enrollees, as well as doctors and hospitals: prior authorization.
The plans call prior authorization a “utilization management tool” designed to keep costs down by requiring all Medicare Advantage members to request permission before they receive medical care. If a plan determines the requested care would be unnecessary or could be provided for less money elsewhere, it can—and will—deny the requests.
