What’s Happening
Starting January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) will begin testing a prior-authorization process for Original (Traditional) Medicare in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Historically, prior authorization has been a feature of Medicare Advantage — not Original Medicare.
Why Now?
CMS aims to combat fraud, waste, and abuse by focusing on 17 high-risk services identified as having little evidence-based benefit or being prone to unnecessary use. These include treatments such as:
- Deep brain stimulation (for Parkinson’s or essential tremor)
- Epidural steroid injections (pain management)
- Arthroscopic procedures for knee osteoarthritis
- Skin and tissue substitutes for chronic wounds
The key takeaway: Traditional Medicare is losing one of its biggest advantages—no prior authorization. With that changing, there’s little reason to choose it over better alternatives. The strongest protection now comes from a well-structured Medicare Advantage plan paired with Living Benefits coverage, just like we offer through our BBR Strategy Plan.
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