Humana to Reduce Prior Authorizations, Increase Transparency for Medicare Advantage Plans by 2026

Humana, the second largest provider of Medicare Advantage plans, will reduce its use of prior authorizations and speed up the process for others by 2026. The company aims to streamline prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace, and commercial plans, covering nearly 80% of Americans. Humana will publicly report its prior authorization metrics in 2026, including data on requests approved, denied, and approved after appeal.

Humana, the second-largest provider of Medicare Advantage plans, has announced significant changes to its prior authorization processes, aiming to streamline them by 2026. These reforms are part of a broader industry effort to reduce administrative burdens on patients, caregivers, physicians, and healthcare organizations. The company has pledged to reduce prior authorization requirements and make the process faster and more seamless for all stakeholders.

Humana's plan includes eliminating approximately one-third of prior authorizations for outpatient services by January 1, 2026. This includes removing authorization requirements for diagnostic services such as colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs. The company aims to streamline the approval process, committing to provide a decision within one business day for at least 95% of all complete electronic prior authorization requests by the same date. Currently, Humana responds within one business day for over 85% of outpatient procedures.

In addition, Humana will launch a new "gold card" program in 2026, which will waive prior authorization requirements for certain items and services for providers who have a proven track record of meeting medical criteria and delivering high-quality care with consistent outcomes for Humana members.

The company has also committed to increased transparency, publicly reporting its prior authorization metrics in 2026. This data will include requests approved, denied, and approved after appeal, as well as the average time between submission and decision. This move aligns with ongoing federal transparency requirements.

Humana's efforts are part of a broader industry pledge to address prior authorization burdens, signed by dozens of insurers and supported by major lobbying organizations. The company's actions are aimed at reducing the administrative burden on physicians and improving patient care.

References:

[1] https://www.kiplinger.com/retirement/medicare/humana-to-reduce-prior-authorizations-for-medicare-advantage-plans-in-2026
[2] https://www.fiercehealthcare.com/payers/humana-makes-commitments-streamline-prior-authorization-process
[3] https://hitconsultant.net/2025/07/24/humana-accelerates-prior-authorization-reforms/