Does Medicare require prior authorization?

Cindy George for GoodRx

Does Medicare require prior authorization?

Medicare Advantage plans often require prior authorization . But these coverage reviews are rare for original Medicare . That distinction changes in 2026. Many older adults choose original Medicare ( Part A and Part B ) to avoid prior authorization. This step, which can delay and deny care, is common with private Medicare Advantage plans.

Starting Jan. 1, 2026, a six-year pilot program in six states will use prior authorization to review certain services and supplies for original Medicare enrollees. This means that recommended care by a healthcare professional could be denied if you receive care in the targeted states. GoodRx, a platform for medication savings, shares what this could mean for those who rely