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Medicare AI Pilot: Hope or Hurdle for Patients?
4 Feb
Summary
- Medicare pilots AI for prior authorization in six states starting Jan 2026.
- Providers must seek AI approval for 14 procedures, including injections.
- AI's impact on patient care and provider workload remains uncertain.
Medicare initiated a six-year pilot program in January 2026, introducing artificial intelligence for prior authorization in six states. This experimental model requires medical providers to seek AI software approval before performing 14 specific health procedures and devices for traditional Medicare beneficiaries.
The program aims to curb wasteful spending by identifying potentially unnecessary or harmful treatments, similar to practices in Medicare Advantage plans. However, experts caution that this change could delay or impede essential care and increase administrative burdens for healthcare providers.
Participating states include Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The pilot, ending in December 2031, targets services like steroid injections for pain management. If deemed successful by the Centers for Medicare & Medicaid Services, the program could expand.
