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Medicare Advantage

CMS Says Medicare Advantage Plans Cannot Hide Required Prior Authorization Data Behind a Password

New CMS guidance makes clear that Medicare Advantage insurers must present mandatory prior authorization statistics in formats that patients and providers can easily find and read, not buried or locked behind a login screen.

By the Goodsurance editorial teamAugust 22, 2026

The Centers for Medicare and Medicaid Services issued guidance directing Medicare Advantage plans on how to properly comply with requirements to publicly disclose prior authorization data, according to an August 20, 2026 analysis by the Medicare Rights Center. The guidance follows a 2024 regulation that first required private Medicare plans to report publicly how often they use prior authorization, how often they deny requests, and how often those denials are overturned.

CMS stated in the new guidance that placing required data behind a login screen or in an obscure section of a plan website does not satisfy the public disclosure rule. The agency asked plans to use visual formats such as charts and tables and provided a template to help organize the information in a way that patients and health care providers can readily understand. Prior authorization lists must also describe covered services in plain language, not exclusively in billing codes or clinical shorthand.

CMS: Medicare Advantage plans cannot hide their prior auth denial rates behind a password. Data must be easy to find and written in plain language.

The guidance arrives after the first wave of mandatory data showed that roughly 12 percent of standard Medicare Advantage prior authorization requests were denied in 2025, drawing scrutiny from advocates and policymakers.

The Medicare Rights Center identified a continuing gap: the disclosure requirement covers prior authorization for Part B drugs and medical services but does not yet extend to Part D prescription drugs, leaving a significant category of Medicare drug coverage without the same level of mandatory public transparency.

In plain words

Medicare private health plans have to publish information about which treatments need prior approval and how often those requests are denied. New guidance says plans cannot hide this information behind a password or bury it on their website. The information must be written in plain words that patients can understand. One gap remains: the same rules do not yet cover prescription drug prior approvals.

Understand the basics first

Source: Medicare Rights Center
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