NRLN Action Alert – Tell Your Lawmaker to Prevent Prior Authorization Trial for Traditional Medicare
Click here to tell your members of Congress to prevent the Centers for Medicare and Medicaid Services’ (CMS) 2026 trial for Traditional Medicare prior authorization which has been a disaster for many Medicare Advantage (MA) enrollers. The “trail” is named “Wasteful and Inappropriate Service Reduction” (WISeR).
WISerR would turn our Traditional Medicare Fee-for-Service (FFS) into a prior authorization/ poor service program. A 2022 investigation by the Department of Health and Human Services Inspector General (HHS IG), found that among all requests, private insurers in MA denied 13% of prior authorizations and 18% of payment denials were unlawful under Medicare coverage guidelines. This means that MA plans delayed or denied enrollees access to services that otherwise would have been approved under Traditional Medicare. Wouldn’t it be wiser to clean up this MA mess? That is where the problems are!
Private plans overspend Traditional Medicare by 20% per person. CMS should use AI to tackle this MA cost problem. Surprisingly, on June 27, 2025, CMS announced that they were going to pay the same MA healthcare providers that are guilty of bilking and cheating Medicare to use Artificial Intelligence (AI) to make medical decisions for 27 million seniors in Traditional Medicare.
CMS plans to pay WISeR private companies a bounty to process prior authorization requests to avert expenditures. Our tax dollars will be used to pay to companies that avert expenditures. Companies will be paid more if they deny more requests, thus incentivizing restrictions on necessary care. The foxes in the private plan henhouse will be rewarded to ruin Traditional Medicare.
CMS has identified six states – Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington – for the prior authorization trial to begin on January 1, 2026. Unless Congress prevents this trial, it is likely CMS will implement prior authorization in all states after the 2026 trial. Therefore, it is important to act now to urge your members of Congress to prevent the 2026 trial.
Please take a few minutes to go to https://nrln.org/2022/12/action-alert/#/home/ to send the NRLN’s sample letter to your U.S. Representative and Senators. If you have had experience with prior authorization including delays and/or denials, add your personalized comments to the letter.
Bill Kadereit, President
National Retiree Legislative Network
If the “Click here” in the first paragraph does not work for you follow these easy steps:
- If you have a problem with the link above, then go to https://nrln.org/action-alert/#/home/. Click on the “TAKE ACTION” button below Tell Your Lawmaker to Prevent Prior Authorization Trial for Traditional Medicare.
Next, enter your street address and zip code, and click “GO”. It will present the sample letters for you to email to your U.S. Senators and Representative. If you have a problem with this link, go to www.nrln.org and click on the red “Action Alert” words at the top of the right column of the NRLN website home page. When the Action Alert appears, click on the “TAKE ACTION” link. Enter your street address and zip and click “GO” and follow the steps to email the NRLN’s sample letters.
- When you have accessed the sample letter, to the left of the letters are windows to type in your contact information required by members of Congress so they know they are receiving an email from a constituent. If you have sent previous NRLN emails to your members of Congress your contact information may be automatically displayed.
- Add your personal comments to the letter.
- Click on the “Preview” button and the letters addressed to your two Senators and Representative will appear. Their names will be automatically added in the letter’s greeting. Check to make sure the letters appear correct and then click “Send”.
- If you receive a non-responsive or an evasive answer from your Representative or Senator to this Action Alert, don’t hesitate to ask him/her to be more specific and address the issue and support the bill. Either do a “Respond” to his/her email or click here to use the NRLN’s Compose Your Own Message to reply to your member of Congress. https://nrln.org/action-alert/#/home/
Important – Please read before forwarding: If you are going to forward this email to others, please delete the “Unsubscribe” link at the bottom of this email before forwarding this message. If another person happen to click on the “Unsubscribe” link it will “Unsubscribe” your email address from receiving future NRLN / Chapter emails.
Learn More:
HHS pilot program raises Democratic concerns over Medicare red tape
The Hill Newspaper – August 11, 2025
https://www.yahoo.com/news/articles/goodlander-urges-federal-medicare-officials-221031304.html
Goodlander urges federal Medicare officials to abandon prior authorization expansion
New Hampshire Bulletin – August 5, 2025
Soft Edge Action Alert:
Tell Your Lawmaker to Prevent Prior Authorization Trial for Traditional Medicare
Tell your members of Congress to prevent the Centers for Medicare and Medicaid Services’ (CMS) 2026 trial for Traditional Medicare prior authorization. CMS has identified six states – Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington – for the prior authorization trial to begin on January 1, 2026. Unless CMS’ “Wasteful and Inappropriate Service Reduction” (WISeR) trial is prevented by Congress, it is likely CMS will implement prior authorization in all states after the 2026 trial. Therefore, it is important to take action now to urge your members of Congress to prevent the 2026 trial.
Lawmakers Should Prevent Prior Authorization Trial for Traditional Medicare
Dear Representative
I am requesting that you ask your House of Representative colleagues to join you in preventing the Centers for Medicare and Medicaid Services (CMS) from starting the Wasteful and Inappropriate Service Reduction model (WISeR). The model authorizes a 2026 six-state prior authorization trial in Traditional Medicare.
CMS plans to pay bounties to private companies to process prior authorization requests in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Why should I pay insurers and providers to do what they should be doing now? Go after the crooks in private plans, where the waste is!
WISeR companies will use Artificial Intelligence (AI) to make medical decisions. Some Medicare Advantage insurance companies have already been using AI, often to the detriment of enrollees. WISeR is a pay-before-you-get results scheme. I hope you and your colleagues call for hearings to scrutinize giveaway programs.
In 2022 the Department of Health and Human Services Inspector General found that among all requests, private insurers in MA denied 13% of prior authorizations and 18% of payment denials were unlawful under Medicare coverage guidelines. Wouldn’t it be wiser to clean up this mess first? That is where the problems are!
The 27 million retirees in Traditional Medicare do not want to be forced into Medicare privatization. I want competent medical professional decisions and 20% less cost than private insurance companies currently charge Medicare, and I want fewer delays and denials.
Traditional Medicare has always allowed enrollees to see any doctor and very few services have been subject to prior authorization. It needs to stay that way. Make Fee-for-Service work!
If CMS is allowed to do its six-states trial in 2026 it is likely that afterward it will implement prior authorization for everyone with Traditional Medicare.
I want to hear from you about what you will do to prevent the CMS prior authorization trial.
Sincerely
Lawmakers Should Prevent Prior Authorization Trial for Traditional Medicare
Dear Senator ______:
I am requesting that you ask your Senate colleagues to join you in preventing the Centers for Medicare and Medicaid Services (CMS) from starting the Wasteful and Inappropriate Service Reduction model (WISeR). The model authorizes a 2026 six-state prior authorization trial in Traditional Medicare.
CMS plans to pay bounties to private companies to process prior authorization requests in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Why should I pay insurers and providers to do what they should be doing now? Go after the crooks in private plans, where the waste is!
WISeR companies will use Artificial Intelligence (AI) to make medical decisions. Some Medicare Advantage insurance companies have already been using AI, often to the detriment of enrollees. WISeR is a pay-before-you-get results scheme. I hope you and your colleagues call for hearings to scrutinize giveaway programs.
In 2022 the Department of Health and Human Services Inspector General found that among all requests, private insurers in MA denied 13% of prior authorizations and 18% of payment denials were unlawful under Medicare coverage guidelines. Wouldn’t it be wiser to clean up this mess first? That is where the problems are!
The 27 million retirees in Traditional Medicare do not want to be forced into Medicare privatization. I want competent medical professional decisions and 20% less cost than private insurance companies currently charge Medicare, and I want fewer delays and denials.
Traditional Medicare has always allowed enrollees to see any doctor and very few services have been subject to prior authorization. It needs to stay that way. Make Fee-for-Service work!
If CMS is allowed to do its six-states trial in 2026 it is likely that afterward it will implement prior authorization for everyone with Traditional Medicare.
I want to hear from you about what you will do to prevent the CMS prior authorization trial.
Action Alert Twitter Message
Congress should prevent 2026 CMS trial to require prior authorization for Traditional Medicare. Traditional Medicare has always allowed enrollees to see any doctor and very few services have been subject to prior authorization. It needs to stay that way.
Facebook:
TELL YOUR MEMBERS OF CONGRESS TO PREVENT PRIOR AUTHORIZATION TRIAL FOR TRADITIONAL MEDICARE.
Access the NRLN Action Alert at https://nrln.org/2022/12/action-alert/#/home/ to tell your members of Congress to prevent the Centers for Medicare and Medicaid Services’ (CMS) 2026 trial for Traditional Medicare prior authorization. CMS has identified six states – Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington – for the prior authorization trial to begin on January 1, 2026. Unless CMS’ trial is prevented by Congress, it is likely CMS will implement prior authorization in all states after the 2026 trial. It is important to take action now to urge your members of Congress to prevent the 2026 trial.
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Congress should prevent 2026 CMS trial to require prior authorization for Traditional Medicare which has always allowed seeing any doctor and few services required prior authorization. It should stay that way. Access Action Alert at https://nrln.org/2022/12/action-alert/#/home/
