Medicare Advantage to Change for Millions Under New Plan

U.S. President Joe Biden speaks during an event promoting lower healthcare costs in the East Room of the White House on August 29, 2023 in Washington, DC. Under a new bill, Medicare Advantage's prior authorization process could be changed.

A new bill would change Medicare Advantage for seniors, and many might benefit from faster prior authorization times.

A bipartisan group of senators proposed the Improving Seniors' Timely Access to Care Act, which would make the prior authorization process more efficient, enabling seniors to get faster treatment and reduce unnecessary paperwork.

Senator Tim Kaine, a Virginia Democrat, said prior authorization is the biggest administrative problem health care providers face, as they're required to get pre-approval for treatment, which can lead to long wait times and communication issues that can deprive seniors of the care they need when they need it.

"Older Americans shouldn't be forced to wait to get critical care because their providers are busy dealing with a mountain of paperwork," Kaine said, as reported by WSET in Lynchburg/Roanoke. "This bipartisan legislation would streamline health care processes to ensure that Americans covered by Medicare Advantage can access the care they need more quickly and enable doctors and health care providers to direct more of their time to their patients."

Under the bill, there would be an electronic prior authorization process for Medicare Advantage. That would increase the transparency around the Medicare Advantage prior authorization requirements, bill sponsors said. It would also increase the protections for recipients and require the U.S. Department of Health and Human Services to report to Congress on the program and the electronic prior authorization process.

Chris Fong, CEO of Smile Insurance Group, said there's likely to be pushback by Medicare Advantage plans.

"Medicare Advantage plans claim to use prior authorizations to manage costs and reduce unnecessary medical services," Fong told Newsweek. "However, prior authorizations are viewed by many medical providers and patients as an unnecessary barrier to care."

Currently, most Medicare Advantage beneficiaries often have to wait seven days for a standard medical order to receive prior authorization, while expedited orders can take as long as 72 hours. But under the new legislation, those times could be much shorter.

"I think the bill has a very good chance of being passed," Fong said. "Some potential arguments by insurance companies would be the additional cost to implement the electronic request process and the additional staff that will be needed to process the prior authorizations within the shorter timeframe. If the time frame were to be decreased by half for standard and expedited, it can be argued that the insurance company will need to potentially double their prior authorization team."

Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, said making prior authorizations quicker would be a game changer for many seniors in Medicare Advantage.

"One of the greatest burdens many Medicare Advantage recipients encounter is the 'red tape' associated with getting approval for medical services," Beene told Newsweek. "This process would look to reduce barriers on the front end so patients would have a more streamlined procedure for making use of their benefits."

Still, providers may have concerns about what it would require on their end.

"From an implementation point of view, it's also hard to say how difficult prior authorization would be to implement on a large-scale level," Beene said. "It's a great idea, but it's not clear yet if it's going to be as easy to implement as some think."

Related Articles

Start your unlimited Newsweek trial