Medicare’s New AI Pilot for Pre-Approval: Big Tech’s Next Move to Control Your Care

Heads up, everyone—Medicare is about to pull a stunt that looks like private insurance 2.0, and it involves letting AI bots decide whether you get the medical care you need. Starting January 2026, the Centers for Medicare & Medicaid Services (CMS) will roll out a new pilot program in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington) that uses artificial intelligence to perform prior authorization for certain medical procedures.

For those who’ve dealt with private insurance hell, “prior authorization” means the insurance company has to approve a treatment before you can get it. It often results in delays, denial of care, and mountains of paperwork. Now, Medicare—long the gold standard of public healthcare—is testing this nightmare with AI deciding if you get approval for procedures like skin substitutes, nerve stimulator implants, and knee arthroscopy for osteoarthritis.

Here’s the brutal truth: The AI doesn’t care about your pain or your health—it’s a cost-saving machine. These AI programs are run by private companies with financial incentives to deny care because they get a cut of “savings” from rejecting treatments. And while a human employee will review final decisions, the AI’s “recommendation” heavily influences whether your care gets the green light.

Why This Could Be a Total Disaster for Medicare Patients

This pilot is not just bureaucracy with a fancy algorithm—it’s a declaration that profit and cost-cutting now officially come before patients in Medicare’s traditional program. If you thought Medicare Advantage plans were bad with their denials and delays, wait until AI-powered gates start blocking access to “low-value” care. The procedures targeted may be labeled “low-value” but can be lifesaving or critical for quality of life for many.

Doctors and medical groups like the American Medical Association are already sounding alarms. They warn that this AI-powered prior authorization could increase denials, add massive guesswork and administrative headaches, and delay care—not exactly what you want when you’re sick. And Congress members, including Rep. Alexandria Ocasio-Cortez, are pushing back hard, demanding the program be halted before it wrecks the integrity of Medicare, turning it into the worst of the privatized insurance world.

The bleak reality? This AI pilot is another step toward privatizing Medicare and putting private companies in charge of your health decisions, all while voters pay higher premiums and face reduced care.

How to Fight Back: Find Your Senators and Representatives Online

Don’t wait for the disaster to unfold. Find out who represents you in Congress and start raising hell:

• Go to house.gov, use the “Find Your Representative” tool by entering your ZIP code.
• Head over to senate.gov to find your Senators by picking your state.

Reach out, share your concerns, demand transparency and oversight of this AI pilot program before it screws millions of Medicare patients over.

Write This Letter to Demand Scrutiny of AI Pre-Approval in Medicare

Here’s a template for your message to Congress:

Subject: Stop the AI-Powered Prior Authorization Pilot That Threatens Medicare Patients

Dear [Representative/Senator] [Last Name],

I am writing to express urgent concern over the Centers for Medicare & Medicaid Services’ new AI-driven pilot program (WISeR Model) that requires prior authorization for certain medical procedures.

While the goal of reducing waste and protecting taxpayer dollars sounds good, the use of AI algorithms operated by private companies to decide if care is “necessary” risks denying or delaying lifesaving treatments. This program mirrors the harmful practices seen in private Medicare Advantage plans, where profit motives have led to dangerous care restrictions and patient harm.

I urge you to demand comprehensive scrutiny of this program, protect patients’ rights to timely, effective care, and ensure Medicare remains a public, patient-centered program—not a profit-driven machine.

Thank you for your attention.

Sincerely,
[Your Name]
[City, State]

Bottom Line

Medicare using AI to police care is a dangerous experiment that could turn public healthcare into a denial-riddled, profit-chasing nightmare like private insurance. It’s time to raise your voice and push Congress to stop this madness before it’s too late.

This new pilot isn’t just about technology—it’s about who controls medical decisions: patients or corporations? The stakes couldn’t be higher.