CMS Mandates Reporting for Medicare Advantage Plans by 2027

CMS Pushes Medicare Advantage Toward Greater Transparency on Coverage Decisions

The Centers for Medicare and Medicaid Services is turning up the focus on how Medicare Advantage plans make coverage decisions. By 2027, all Medicare Advantage insurers will be required to report detailed data on initial coverage determinations and appeals. Ahead of that deadline, CMS is inviting plans to participate in a voluntary pilot program slated for late 2026.

The goal is straightforward. CMS wants clearer insight into prior authorization practices, particularly as artificial intelligence and automated tools play a growing role in utilization management. For insurers, the initiative signals both a compliance milestone and an opportunity to shape how reporting standards ultimately take form.

“This data will be critical to ensuring that coverage decisions are timely, appropriate, and transparent for beneficiaries and providers.”
CMS, agency memo to Medicare Advantage plans

A Focus on Speed, Clarity, and Trust

In ongoing discussions with Medicare Advantage organizations, CMS has outlined a set of voluntary reforms aimed at reducing delays and improving communication around care decisions. These efforts are designed to address long standing provider and beneficiary concerns about opaque denials and slow turnaround times.

From the agency’s perspective, early progress has been encouraging. CMS has pointed to growing alignment with plans on the value of standardized data collection as a foundation for better oversight and smoother care delivery. Industry leaders largely agree that consistent reporting can help regulators and plans alike better understand utilization trends, denial rates, and the real world impact of prior authorization policies.

“Without comprehensive, comparable data, it is difficult to assess how prior authorization affects access to care and overall spending.”
Medicare Payment Advisory Commission

What Insurers Will Be Asked to Report

The forthcoming reporting framework is expected to shine a light on how decisions are made at the plan level, including the role of internal criteria and third party vendors. While CMS continues to refine the details, insurers should anticipate reporting in several key areas.

• Initial coverage decisions, including approval and denial rates, appeal and reconsideration outcomes, decision timeframes, and the rationale used to support determinations.

Why the Pilot Matters

While the reporting mandate does not take effect until 2027, the 2026 pilot is more than a dress rehearsal. Some stakeholders have raised concerns that the timeline may be tight, especially given the complexity of collecting and validating new data streams across large Medicare Advantage portfolios. Others question whether a voluntary pilot will generate enough participation to give CMS a complete picture.

At the same time, the pilot offers insurers a chance to identify operational gaps early, test data infrastructure, and engage directly with regulators on practical challenges. For plans that rely heavily on prior authorization, especially those incorporating AI driven tools, early participation could help mitigate future compliance risk.

Implications for Oversight and the Market

CMS has been clear that plan level reporting is intended to strengthen regulatory oversight and improve data accuracy. Over time, the information could inform policy decisions, consumer choice, and even competitive positioning within the Medicare Advantage market.

The Medicare Payment Advisory Commission has repeatedly flagged gaps in visibility around Medicare Advantage spending and access to care. More granular reporting on denials and appeals could help close those gaps, while also encouraging plans to reassess claims processing workflows and risk management strategies.

Key Dates at a Glance

For insurers, the message is clear. Transparency around coverage decisions is no longer a future concept. It is becoming a core expectation. Plans that engage early may be best positioned to adapt efficiently, demonstrate accountability, and reinforce trust with regulators, providers, and the seniors they serve.