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.

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
Read at the source →

More news

Other stories on what is moving in Medicare.

Medicare Advantage

When a Medicare Advantage Hospital Goes Out of Network Mid-Year, Federal Rules Offer Little Automatic Relief

As hospital systems continue dropping Medicare Advantage contracts in 2026, the absence of a guaranteed plan-switch window and the limited reach of continuity-of-care rules are receiving increased scrutiny from researchers and consumer advocates.

August 19, 2026

Medicare Advantage

CMS Removed 11 Quality Measures From Medicare Advantage Star Ratings for 2027 and Dropped a Health Equity Bonus Program

A CMS final rule from April 2026 restructures how Medicare Advantage plans are graded starting with the 2027 measurement period, eliminating measures tied to administrative processes and reversing a prior-administration health equity reward. The agency projects the shift will send about 18.5 billion dollars more to plan sponsors over the next ten years.

August 18, 2026

Medicare Advantage

Court-Ordered Star Rating Recalculation Will Add About 600 Million Dollars to 2027 Medicare Advantage Bonus Payments, KFF Finds

An August 12 KFF update to its quality bonus analysis finds that CMS's voluntary decision to extend a court-mandated star rating fix to all Medicare Advantage plans will push 2027 insurer bonus payments roughly 600 million dollars higher than they would otherwise have been.

August 17, 2026

Medicare Advantage

Medicare Advantage Supplemental Benefit Cards Must Verify Purchases Electronically at Checkout Starting in 2027

A finalized CMS rule requires that Medicare Advantage debit cards for over-the-counter and food benefits be restricted electronically to plan-covered items at the point of sale, with unused balances no longer rolling over to the next year.

August 14, 2026

Medicare Advantage

Medicare Advantage Plan Count Fell Nine Percent in 2026, Leaving Beneficiaries Fewer Choices Heading Into 2027 Open Enrollment

KFF data shows that 3,373 Medicare Advantage plans were available for individual enrollment in 2026, nine percent fewer than in 2025, and the average beneficiary could choose from 32 drug-covering plans, down from a peak of 36 in 2024.

August 12, 2026

Medicare Advantage

Starting in 2027, Medicare Advantage Plans Are No Longer Required to Tell Enrollees About Benefits They Have Not Used

A consumer-protection rule that required Medicare Advantage plans to send mid-year notices about unused supplemental benefits was rescinded in the 2027 Medicare Advantage final rule, placing the responsibility for tracking dental allowances, over-the-counter cards, and similar extras on enrollees.

August 8, 2026