Oncology in Medicare Advantage: the care between the authorization and the claim

Medicare Advantage covers 55% of eligible beneficiaries, and 58% of new cancers are diagnosed at 65 or older. The prior authorization is the only point at which a plan sees a cancer episode, and from January 2026 that decision is clocked and published. Ten pages on the rules, the delay literature, the avoidable acute care after the decision, and what a plan can measure from the data it already holds.

Arca

Oncology in Medicare Advantage

What an MA plan sees at prior authorization, what the 2026 rules change, and where the avoidable spend sits in the months after the decision.

Cancer is a Medicare Advantage line of business
The authorization is the plan's only touchpoint
The 2026 rules clock the decision and publish the result
Prior authorization delay is a clinical cost
The avoidable spend sits after the decision
Episodes are managed one at a time and measured across the network
What a program should measure

September 2026 · 10 pages · 27 sources

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