Big Changes Coming to Traditional Medicare in 2026: What You Need to Know About Prior Authorization

If you or someone you care about is covered under Traditional Medicare, there's a major policy change on the horizon that could affect how care is approved and delivered. Starting 2026, prior authorization will be required for certain outpatient services under Medicare — a shift that’s already sparking debate in healthcare and policy circles.

What Is Prior Authorization?

Prior authorization is a process where healthcare providers must get approval from Medicare before delivering certain medical services to ensure they’re deemed “medically necessary.” It's already common in Medicare Advantage plans, but this is the first time it will be required in Traditional Medicare.

Why the Change?

The Centers for Medicare and Medicaid Services (CMS) say this shift is designed to:

• Prevent fraud and unnecessary treatments

• Cut costs

• Improve oversight of high-risk services

While the intentions may be valid, many experts worry that this move could create delays in care, especially for seniors who already face enough red tape when accessing health services.

Who Will Be Affected?

If you or your loved ones rely on:

• Outpatient procedures

• Diagnostic tests

• Imaging services

…then this change could impact you directly. Providers will need to submit documentation in advance, and approval must be granted before moving forward with these types of services.

Concerns & Pushback

Critics argue that adding prior authorization requirements could:

• Overwhelm providers with more administrative work

• Delay patient care, especially for time-sensitive issues

• Burden older patients who may not fully understand the approval process

Some health policy groups are urging CMS to reconsider or delay implementation, citing the need for transparency and clear guidelines.

What Should You Do?

• Talk to your doctor about how this may impact your care after 2026

• Stay informed through trusted sources like Medicare.gov

• If you're a caregiver or advisor, now is a good time to start preparing clients or family members for these changes

Bottom Line

While the goal of prior authorization may be to protect the system from abuse, it’s essential to balance that with timely, high-quality care for beneficiaries. With healthcare already complicated, these additional requirements could introduce new challenges.

🔗 Read the full article on Kiplinger for more insight:
Prior Authorization Coming to Traditional Medicare