Policy Priorities

Innovation in service of affordable, high-quality care for seniors has always been a hallmark of the Medicare Advantage (MA) program. Given all that has been learned since MA’s inception, Humana is committed to working with the Administration and Congress to strengthen the program, so it can continue to meet the needs of patients, providers, and taxpayers for generations to come.

Prior authorization builds important checks and balances into the healthcare system by verifying that high-risk, high-cost treatments are in the best interest of patient safety and quality of care, while safeguarding taxpayer dollars. Still, this additional step in the process can be deeply frustrating, and we are committed to making the process faster and more seamless for patients and providers.

In June 2025, Humana joined other industry partners in making specific commitments to streamline and simplify prior authorizations. The following month, we built on that progress by announcing  additional company-specific actions.  Humana has also long supported the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would modernize the prior authorization process. Lastly, we were pleased to be among the industry’s first signatories to the CMS-led pledge designed to help ensure that doctors, hospitals, and health plans have timely and secure access to the information they need to deliver better, more coordinated care to patients.

• Beckers: How Humana is redesigning the prior authorization process 
• Healthcare Finance: Humana pledges to simplify prior authorization process

Risk adjustment is the process by which CMS provides funding for MA plans to cover the health needs of seniors, 80% of whom suffer from two or more chronic conditions. While risk adjustment has successfully eliminated the financial incentive for plans to pick and choose the healthiest beneficiaries, more can be done to ensure that the tools plans use to determine the health needs of their beneficiaries result in correct diagnoses, accurate payment, and needed follow-up care.

With a variety of MA plans to choose from, Medicare-eligible seniors need complete and accurate information to make the right choice for their needs. Beneficiaries often access this information through MA plans, third-party marketing organizations (TPMOs), and insurance agents and brokers. To encourage choice and competition, TPMOs work with multiple M A plans simultaneously to help seniors understand their options across carriers. Too often, however, some consumers have reported being confused or frustrated by misleading marketing tactics. Humana supports changes that would help beneficiaries better understand their coverage options and reduce costs for taxpayers.

Star Ratings provide beneficiaries with important information about an MA plan’s quality, while also incentivizing high-quality care. For example, rates of preventive screenings have increased significantly since the inclusion of screening measures in Stars. Yet despite its success, Stars can do more to improve clinical outcomes. Humana supports a simplified, outcome-oriented Star Rating system. This would improve stability and predictability while promoting better health for beneficiaries.

Even when veterans have access to VA healthcare, VA encourages them to sign up for Medicare to give them more options. This is especially valuable for veterans who lack convenient access to doctors and hospitals, face long wait times for care, or are concerned about emergency department visits in their community not being covered by VA. As a result, a growing number of veterans are choosing MA plans to complement their VA benefits. These plans provide access to a broader network of providers and offer additional benefits such as vision, dental, hearing, and affordable premiums. These MA plans also provide veterans with flexibility and the option to see civilian doctors and specialists, while continuing to access their VA coverage, which prioritizes specialized treatment for service-connected injuries and illnesses.

While CMS already adjusts payments to MA plans to account for dually-enrolled veterans who receive care through VA, data sharing between VA and key stakeholders – including CMS, Medicare clinicians, and MA plans – is limited. Given the aging population of veterans and increasing complexity of their healthcare needs, Humana supports increased coordination between CMS and VA to better ensure beneficiaries have seamless access to the healthcare coverage they have earned through the VA and Medicare.