Insurers Pledge to Fix Broken Prior Authorization System — What It Means for Older Adults

Health insurers covering nearly 80% of Americans have pledged to overhaul the nation’s broken prior authorization system — a move that could significantly ease care delays, especially for older adults and their caregivers.

In a landmark announcement Monday, Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz unveiled a series of voluntary reforms from top insurers. These changes aim to speed up medical approvals, improve transparency, and reduce the paperwork burden for patients and providers.

This is a big win for patients. Americans shouldn’t have to negotiate with their insurer to get the care they need. Pitting patients and doctors against massive companies wasn’t working for anyone. — Health and Human Services Secretary Robert F. Kennedy, Jr

What’s Changing — and Why It Matters

The prior authorization process is a common point of frustration, particularly for older adults enrolled in Medicare Advantage or Medicaid Managed Care.

It can delay access to physical therapy, imaging tests, outpatient surgeries, and other necessary care.

Under the new pledge, insurers including UnitedHealthcare, Aetna, Humana, Cigna, Elevance, Blue Cross Blue Shield Association, and Kaiser Permanente committed to:

• Standardizing digital authorizations using FHIR® technology
• Reducing the number of services requiring prior authorization by January 1, 2026
• Allowing care to continue when a patient switches insurance plans
• Improving transparency around denials and appeals
• Expanding real-time approvals for most services by 2027
• Requiring clinical review of all denials

CMS Administrator Dr. Oz said the goal is to restore trust and reduce burdens.

There shouldn’t be paper...90-day continuity should exist when patients switch insurers, so you never fall through the cracks again,” Oz said in an interview with Reuters. “We’re putting patients first — and keeping government red tape out of the way.

A Lifeline for Seniors and Their Families

For adults over 65 and those managing chronic illness or dementia, delays caused by prior authorization can mean postponed treatment, unnecessary ER visits, or even long-term institutional care. The new reforms aim to minimize these risks.

Experts have said that care disruptions are especially harmful for older patients who rely on consistency. If this pledge is followed through, they say it will be a step toward safer, more coordinated care.

Caregiver Burdens Could Ease

Caregivers often spend hours chasing down authorizations or navigating appeals. A 2024 AARP survey found that more than 60% of family caregivers had experienced delays due to insurance hurdles.

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American families are also dealing with the high costs of long-term care services as chronic illness or aging-related issues require them to need help with daily living activities.

Medicare will not pay for long-term care outside a limited amount of skilled care. Medicaid will pay for long-term care services for those with limited financial resources.

Families looking for professional care services for a loved one should use the LTC News Caregiver Directory to find licensed in-home caregivers or facilities — especially those familiar with navigating prior authorization on behalf of clients. Often, an older adult in an extended care facility will need a medical service and will wait for authorization before being transferred to a hospital.

Bipartisan Support in Congress

The announcement drew praise from both sides of the aisle.

This is an important topic that has continued to be an issue for far too long. I applaud the leadership of Secretary Kennedy and President Trump for bringing us all to the table to find solutions for our patients and providers. — Senator Roger Marshall, M.D. (R-KS)

Representative Greg Murphy, M.D. (R-NC), co-chair of the House GOP Doctors Caucus, said he has witnessed how insurance companies can delay decisions.

As a physician for over 30 years, I witnessed the ridiculous and ever-increasing obstructions caused by insurance companies to delay or deny care to patients. These bureaucratic hurdles hurt patients and those who care for them. — Greg Murphy, M.D. (R-NC)

What Comes Next?

CMS will monitor insurer compliance and may pursue additional rulemaking if voluntary reforms fall short.

Key timelines to watch:

• January 1, 2026: Reduction in services requiring prior authorization
• By 2027: Real-time decisions expected for most routine care

Insurers that signed the pledge cover an estimated 75% of Americans. CMS plans to publish a public scorecard later this year to track progress.

Bottom Line for Older Adults

If you or a loved one is enrolled in Medicare Advantage or Medicaid Managed Care, you could see faster approvals and fewer interruptions in your care. But families must stay proactive. 

When evaluating a care facility or in-home provider, ask how they handle prior authorizations — and whether they assist with appeals.