You’ve probably seen the headlines by now: Centers for Medicare and Medicare Services (CMS) is preparing to test prior authorization for certain procedures in a handful of states. This new prior authorization pilot is called “WISeR” and CMS is planning to use Artificial Intelligence (AI) as the first line of defense to determine who gets approved treatment for certain conditions. The idea might sound reasonable enough to reduce waste and prevent unnecessary treatments. But here’s the thing: this could end up changing the best parts of Medicare while retaining the worst!
Medicare’s Core Strength
Medicare is far from perfect. Enrolling can be a headache with confusing deadlines, steep penalties, and the alphabet soup of Plans and Parts. The seemingly arbitrary rules for when you can enroll or switch certain Medicare insurance plans needs reform.
But once you’re enrolled in Original Medicare, however, you can take comfort in the fact that you can see nearly any doctor in the United States without referrals. Over 98% of non-pediatric doctors accept Medicare (source) which makes finding care easy compared to the restrictive networks of private insurers. Importantly, insurance companies currently play no role in U.S. based treatment decisions when you Original Medicare (with or without a supplemental Medigap plan). Case by case Medicare authorizations are extremely rare. That’s a feature not a bug- it cuts down on bureaucracy and lets doctors and patients focus on health outcomes rather than paperwork. Supporting that direct doctor–patient relationship is a core promise of Medicare.
What WISeR Means
WISeR is an acronym for “Wasteful and Inappropriate Service Reduction.” The pilot will launch Jan 1, 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington State. If implemented, WISeR could recreate the same frustrations that make Medicare Advantage so unpopular: delays, denials, and red tape. We talk to older adults every day, and many tell us they’ve chosen Original Medicare specifically to avoid the hoops of prior authorization. Now it feels like the rules are changing for people who thought they were signing up for something straightforward and dependable.
Medicare’s AI Problem
And then there’s the Artificial Intelligence piece, which is concerning. Sure, these systems can scan through paperwork quickly, but they don’t get the full picture of what’s going on with each patient. They can’t read between the lines or understand when someone’s health situation is more complicated than it looks on paper. CMS says human doctors will make the final calls, but we’ve seen how this plays out with Medicare Advantage: too often, that “human review” becomes little more than a rubber stamp on what the algorithm already decided. The result? More delays, more denials, and more patients too exhausted to fight back.
What at Stake
We all agree that Medicare dollars shouldn’t be wasted but AI-driven prior authorization isn’t the solution. Medicare was meant to be the simple option—the one that doesn’t make you jump through hoops to get care.
The American Medical Association (AMA) has also expressed concern, stating:
“The AMA strongly urges CMS to pause the January 1, 2026 implementation of the WISeR Model to allow additional stakeholder input, full analysis of the model’s operational impacts, and development of clear guidance for physicians.” (source)
Before CMS imports the worst parts of private insurance into traditional Medicare, it should listen to the people who rely on it most: seniors.
If WISeR concerns you, contact your elected officials. Urge them to support common-sense Medicare reforms—simplify enrollment rules, protect patient choice—and press pause on these new AI authorizations.