Medicare Advantage plans' prior authorizations to be eliminated by Humana by 2026.
In a significant move aimed at simplifying the healthcare system, Humana, the second largest provider of Medicare Advantage plans, has announced its commitment to reducing prior authorization requirements and speeding up the process for its enrollees.
At a Health and Human Services (HHS) roundtable attended by Secretary Kennedy and CMS Administrator Dr. Oz, Jim Rechtin, President and CEO of Humana, stated that today's healthcare system is too complex, frustrating, and difficult to navigate. He emphasized that Humana is dedicated to making the process faster and more seamless.
The company's plan to reduce prior authorization wait times is designed to significantly ease and speed up access to outpatient services by eliminating about one-third of prior authorization requirements on common diagnostic procedures such as colonoscopies, certain heart monitoring tests, and specific CT and MRI scans. This reduction aims to remove administrative barriers that often delay care and create frustration for patients.
For Medicare Advantage enrollees, this means faster, smoother access to necessary diagnostic tests and treatment without the usual wait for insurer approval. This improvement can lead to quicker diagnosis and initiation of treatment, enhancing patient experience and potentially health outcomes.
Healthcare providers will also benefit from the reduced administrative burden. With fewer prior authorizations to process and a commitment from Humana to provide decisions within one business day for at least 95% of electronically submitted requests (up from about 85%), providers can operate more efficiently and focus more on patient care rather than paperwork.
Humana has joined other signatories in a pledge to streamline prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace, and commercial plans, covering nearly 80% of Americans. This initiative aligns with broader industry efforts to streamline prior authorization protocols, reduce red tape, increase transparency, and improve communication between insurers and healthcare providers, which may influence wider reform of prior authorization practices across the U.S. healthcare system.
These changes are expected to take full effect by January 2026. With Humana's commitment to reducing prior authorization requirements, Medicare Advantage enrollees can look forward to reduced delays and stress, while healthcare providers face less administrative work and faster insurer decisions. The plan balances reducing unnecessary approvals with maintaining safety checks for high-cost, high-risk treatments.
- The commitment by Humana to reduce prior authorization requirements aligns with policy-and-legislation efforts aimed at simplifying the healthcare system, particularly in regard to Medicare Advantage plans.
- As health-and-wellness becomes increasingly central to political discussions, the reduction of prior authorization wait times by companies like Humana could potentially influence policy reforms in general-news, affecting millions of Americans enrolled in Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace, and commercial plans.
- The science behind diagnostic procedures such as colonoscopies, heart monitoring tests, CT and MRI scans could see improvement with the removal of administrative barriers that result from burdensome prior authorization processes, a focus of Humana's ongoing collaboration with other industry leaders in the field of policy-and-legislation and regulation.
