New Bill Mandates Electronic Prior Authorization and Faster Decisions for Medicare Advantage Starting in 2028

If you or someone you care about is on Medicare Advantage, you know the headache that is prior authorization—that bureaucratic hurdle where the insurance plan has to approve a service or item before the doctor can actually deliver it. It’s notorious for causing delays, especially when dealing with paper forms and faxes. This bill, the Improving Seniors’ Timely Access to Care Act of 2025, aims to drag that process into the digital age and speed things up.

The End of the Fax Machine Era?

The biggest change targets the technology behind the approval process. Starting January 1, 2028, Medicare Advantage plans will be required to use secure, standardized electronic systems for sending and receiving prior authorization requests. This isn’t just swapping a fax machine for an email; the bill explicitly says these systems must meet federal technical standards. Think about it: instead of a doctor’s office waiting days for a fax reply or navigating a clunky, proprietary website, the system should allow for much smoother, faster communication. For a senior needing a specific medical device or procedure, shaving days or weeks off that approval time can make a massive difference in their quality of life.

Putting the Pedal Down on Decision Times

Beyond going electronic, the bill gives the Secretary the authority to set much tighter deadlines for plans to respond. This includes the possibility of requiring “real-time decisions”—potentially within 24 hours—for items and services that are routinely approved. Right now, approval times can be all over the map. This provision means that for common, low-risk procedures that almost always get the green light, the delay could essentially disappear. However, the bill leaves the exact definition of “real-time” and how it will work up to future rulemaking by CMS, which is where we’ll need to watch for the fine print.

Transparency and Accountability

Starting earlier, on January 1, 2027, Medicare Advantage plans are going to have to open their books on prior authorization. They must report extensive data annually to the government, including the percentage of requests approved and denied, how many denials were overturned on appeal, and the average time it took them to make a decision. This data will eventually be made public on the CMS website, broken down by individual plan. This is huge for consumers and providers. It means you’ll be able to see which plans are fast and fair, and which ones are slow-walking approvals. For the first time, plans will be publicly held accountable for their prior authorization performance.

A Waiver for the Good Guys

The bill also introduces a smart incentive aimed at reducing administrative waste: plans can waive or adjust prior authorization requirements for providers who consistently follow evidence-based medical guidelines and meet high-quality standards. This is a game-changer for high-performing doctors and clinics. If your provider has a track record of doing things correctly, they might be able to skip the authorization step entirely, leading to immediate access for their patients. The flip side is that providers who don’t meet those standards will likely remain stuck in the old system. While this is a great idea, the bill is currently vague on what those “high-quality standards” actually are—that definition will determine how widely this waiver is used.

Who Pays the Tab?

While this is a clear win for seniors and providers, the administrative burden falls squarely on the Medicare Advantage plans. They have to design, implement, and maintain these new electronic systems by 2028, and they have to dedicate significant resources to the new, extensive annual reporting requirements. This is a major compliance lift. The hope is that the long-term efficiency gains will outweigh the initial cost, but it’s a necessary investment to modernize a system that has long been a source of frustration for everyone trying to navigate senior healthcare.