Medicare Advantage plans can require prior authorization for many services including: specialist visits, inpatient hospital stays, outpatient procedures, durable medical equipment, home health care, skilled nursing facility care, and specialty medications. Original Medicare with Medicare Supplement does not require prior authorization.
Key Points
- Medicare Advantage can require prior authorization for many services
- Common prior auth requirements: specialist visits, inpatient stays, procedures, DME, home health, SNF, specialty drugs
- Original Medicare with Medicare Supplement: no prior authorization required
- Denied prior authorization: you can appeal the decision
- An independent agent can help you find plans with fewer prior authorization requirements