Fact Sheet: Prior Authorization in Medicare Advantage
Medicare Advantage plans use various medical management and care coordination tools to ensure beneficiaries receive the most clinically appropriate and cost-effective care.
A commonly used tool is prior authorization, in which the beneficiary’s health care provider works with the health plan to make certain a treatment or service is the best option for the needs of the individual patient. It works to guarantee the most appropriate option available is used and that it will be covered by the health plan.
Prior authorization promotes better, smarter health care delivery and protects seniors from unnecessary services and unexpected medical bills when deployed appropriately.