Humana Plans to Eliminate Prior Authorizations for Medicare Advantage Programs by 2026
In a significant move towards improving healthcare accessibility, Humana, the second-largest provider of Medicare Advantage plans, has announced plans to reduce prior authorization wait times and simplify the process for its patients.
By the start of 2026, Humana aims to eliminate about one-third of prior authorization requirements for outpatient services, including common diagnostic procedures such as colonoscopies, transthoracic echocardiograms, and select CT and MRI scans [1][2][3][4][5]. This decision is expected to allow faster access to necessary care for patients.
To achieve this goal, Humana is implementing several key strategies. One such strategy involves eliminating prior authorization for many diagnostic services, enabling swifter access to essential care for patients [1]. Additionally, the company pledges to respond to at least 95% of electronic prior authorization requests within one business day starting January 1, 2026, significantly improving on their present 85% rate [1][2][3][4][5].
Later in 2026, Humana will launch a program dubbed the "Gold Card" program, which will exempt providers with a proven record of high-quality care from prior authorization requirements, further streamlining access [1].
In an effort to increase transparency and reduce administrative burden, Humana will publicly report prior authorization metrics (e.g., approval rates, wait times) and enhance interoperability to move away from fax and phone requests towards electronic workflows for providers [1][3][4][5].
These efforts align with broader industry commitments to simplify prior authorization and reduce delays in care for Medicare Advantage beneficiaries, while maintaining necessary checks for medical necessity and safety [1][3][4][5]. The commitment was made 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 the current healthcare system is too complex, frustrating, and difficult to navigate, and that Humana is committed to reducing prior authorization requirements and making the process faster and more seamless [1].
While UnitedHealthcare, the largest provider of Medicare Advantage plans, continues to require prior authorization for certain services and procedures, it does not require it for emergency or urgent care [1]. 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 [1].
According to an analysis by KFF, in 2023, Humana had an average of 3.1 prior authorization requests per MA enrollee and a denial rate of 3.5% [1].
Prior authorizations are tools widely used by private insurance companies to contain costs, make sure the plan covers the service, medication or equipment, and decide if the care is medically necessary, safe, and cost effective. By streamlining this process, Humana's plans could lead to less waiting for patients and less paperwork for doctor's offices.
- The simplification of prior authorization processes for Medicare Advantage plans, as announced by Humana, falls under the broader policy-and-legislation agenda aimed at improving health-and-wellness, and this move aligns with commitments made during a recent Health and Human Services (HHS) roundtable.
- As part of its commitment towards faster access to necessary care, Humana has pledged to reduce the number of prior authorization requirements for outpatient services in the field of science and medicine, including common diagnostic procedures like colonoscopies.
- The implementation of Humana's "Gold Card" program in 2026, which exempts providers with a proven record of high-quality care from prior authorization requirements, is expected to have a significant impact on politics and general news, as it could serve as a model for other providers in streamlining health-and-wellness service access under Medicare.
