Medicare Advantage · Part C

Prior-authorization changes, year over year

Everyone can tell you what a plan requires today. This is what they changed — counted plan by plan from the Medicare Advantage benefit filings each organization submits to CMS, across plan years 2022–2026.

The direction of the market

4 year-over-year transitions

Plan year	Added prior auth	Removed	Net direction
CY2022 → CY2023	1,282	1,935	-653 loosening
CY2023 → CY2024	1,679	3,258	-1,579 loosening
CY2024 → CY2025	1,150	2,327	-1,177 loosening
CY2025 → CY2026	4,870	1,593	+3,277 tightening

Why one year is not enough. Looking only at the most recent transition, prior authorization is tightening sharply. Across the full series it loosened for two consecutive years first, then reversed. A single-year comparison would have described a steady trend that did not happen.

Who moved most, CY2025 → CY2026

self-reported to CMS

Grouped by parent organization — a single carrier files under many subsidiary names, and reporting by legal entity would scatter one payer across dozens of rows.

Between CY2025 and CY2026, Humana Inc. ADDED prior authorization on 362 of 814 comparable plan-segments for Physician specialist visits, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Opioid treatment services, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Eye exams (Medicare-covered), as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Podiatry services, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Cardiac rehabilitation, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Hearing exams (Medicare-covered), as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Physical therapy / speech therapy, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Outpatient substance-abuse services, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Renal dialysis, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Outpatient blood services, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Physician specialist visits, as reported to CMS.
Between CY2025 and CY2026, Devoted Health, Inc. ADDED prior authorization on 224 of 224 comparable plan-segments for Occupational therapy, as reported to CMS.

What a subscription adds

Everything above is free and always will be — it is counted from public CMS files and gating it would protect nothing. What a partner packet answers is the question this page cannot: for this denial, in this state, what does the binding policy say, and since when — with the CMS document linked.

How we work Free denial check

Self-reported, and that is the whole caveat.Every figure is an answer the plan filed with CMS in its Plan Benefit Package — not CLV’s finding, not observed adjudication behaviour, and not a prediction about any individual claim. A plan that did not answer in one year is counted as a disclosurechange and never as a change in what it requires: reporting “stopped answering” as “removed prior authorization” would tell a biller to stop obtaining it. Only plans present in bothyears are compared. Medicare Advantage contracts only — PACE and Section 1876 Cost plans are excluded because they are not Part C. Each plan year is its initial filing. Sourced from the CMS Plan Benefit Package extracts ↗ joined to the monthly enrollment-by-contract file ↗. Both are public. Nothing is modeled or estimated.