By Cindy Hadsell

One of the features of National Retiree Legislative Network (NRLN) is its vigilance on monitoring proposals that may either harm or benefit seniors in the future. NRLN often uses “Action Alerts” to request that we contact our Congress members to provide our opinions.

The current Action Alert is about a trial initiative on Traditional Medicare. It is likely they will implement “prior authorization” in all states after the 2026 trial. Therefore, it is important to take action now to object to the 2026 trial. To add your voice, visit the NRLN Action Alert page – https://nrln.org/2022/12/action-alert/#/home/. Or, you may call your Congress members and talk to their staff.

You may write your own letter, or use this sample letter that NRLN has prepared:

I am requesting that you ask your Senate colleagues to join you in preventing the Centers for Medicare and Medicaid Services (CMS) from starting the Wasteful and Inappropriate Service Reduction model (WISeR). The model authorizes a 2026 six-state prior authorization trial in Traditional Medicare.

CMS plans to pay bounties to private companies to process prior authorization requests in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Why should I pay insurers and providers to do what they should be doing now? Go after the crooks in private plans, where the waste is!

WISeR companies will use Artificial Intelligence (AI) to make medical decisions. Some Medicare Advantage insurance companies have already been using AI, often to the detriment of enrollees. WISeR is a pay-before-you-get results scheme. I hope you and your colleagues call for hearings to scrutinize giveaway programs. In 2022 the Department of Health and Human Services Inspector General found that among all requests, private insurers in MA denied 13% of prior authorizations and 18% of payment denials were unlawful under Medicare coverage guidelines. Wouldn’t it be wiser to clean up this mess first? That is where the problems are!

The 27 million retirees in Traditional Medicare do not want to be forced into Medicare privatization. I want competent medical professional decisions and 20% less cost than private insurance companies currently charge Medicare, and I want fewer delays and denials. Traditional Medicare has always allowed enrollees to see any doctor and very few services have been subject to prior authorization. It needs to stay that way. Make Fee-for-Service work! If CMS is allowed to do its six-states trial in 2026, it is likely that afterward it will implement prior authorization for everyone with Traditional Medicare. I want to hear from you about what you will do to prevent the CMS prior authorization trial.