Prior Authorization

Browse our articles about prior authorization

March 24, 2026

Medicare and AI: How Artificial Intelligence Is Changing Coverage Decisions

How AI is reshaping Medicare coverage decisions in 2026, from the WISeR prior authorization pilot to insurer controversies, and what beneficiaries should know.

Prior Authorization in Medicare: What You Need to Know

Understand how prior authorization works in Medicare, when it applies, how it differs from pre-certification, and recent CMS streamlining rules.

How to Appeal a Medicare Decision

Learn the five levels of Medicare appeals, key deadlines, how to write an effective appeal letter, and where to get free help from SHIP counselors.

Medicare Part D Drug List: How Formulary Tiers and Coverage Work

Understand how Part D formularies are structured, how medications are grouped into tiers, and how to verify your drugs are covered.

Medicare Part D Plan Structure: Coverage Phases and How Plans Work

Understand how Part D prescription drug plans are organized, including coverage phases, formularies, and pharmacy networks.

Medicare Physical, Occupational, and Speech Therapy Coverage

Learn how Medicare covers physical therapy, occupational therapy, and speech-language pathology, including outpatient benefits and cost thresholds.

Does Medicare Cover Genetic Testing?

Learn which genetic tests Medicare covers, including BRCA, Lynch syndrome, and pharmacogenomic testing, plus costs, lab requirements, and scams to avoid.

Does Medicare Cover Knee and Hip Replacement?

Learn how Medicare covers knee and hip replacement surgery, including inpatient and outpatient options, rehab benefits, and expected out-of-pocket costs.

Does Medicare Cover Ozempic and Weight-Loss Drugs?

Find out which GLP-1 drugs like Ozempic, Wegovy, Mounjaro, and Zepbound Medicare covers, what conditions qualify, and what you may pay in 2026.

Does Medicare Cover CPAP and Sleep Apnea Treatment?

Find out how Medicare covers CPAP machines, sleep studies, and sleep apnea supplies, including the rental-to-own process and compliance rules.

Medicare Prior Authorization: New Rules for 2026

New 2026 Medicare prior authorization rules bring faster decisions, electronic requirements, and an AI-assisted pilot in six states. Learn what changed.

Medicare Advantage Benefits and Drawbacks: Is Part C the Right Fit?

Evaluate the advantages and disadvantages of Medicare Advantage plans to decide if Part C is a good fit for your healthcare needs.

This content is for educational purposes only and does not constitute a recommendation of any specific Medicare plan. Benefits, costs, and availability vary by plan and location. For complete information about your Medicare options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY: 1-877-486-2048, available 24 hours a day, 7 days a week.