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Module 4
Utilization Management and Benefits
Prior authorization, networks, and supplemental benefits: the tools that define the member experience, and the rules that now constrain them.
3 lessons About 13 min
By the end of this module, you will be able to:
- Explain what the CY2024 rule requires of MA coverage criteria and prior authorization
- Weigh what a narrow network buys a plan against what it costs members
- Assess how much financial protection supplemental benefits actually provide
- Prior Authorization in Medicare Advantage Prior authorization is MA's sharpest tool and its most criticized. This lesson covers the rules that now constrain it. About 5 min
- Networks and Access Networks are how MA plans manage cost and quality, and how members lose choice. This lesson covers the trade-off honestly. About 4 min
- Supplemental Benefits Dental, vision, hearing, and more are MA's biggest selling point. This lesson asks what they are actually worth. About 4 min
Module quiz
Answer all questions to see your score.
1. Under the CY2024 MA rule, what must plan coverage criteria align with?
This closes the gap where a plan could nominally cover what Medicare covers while applying stricter internal criteria.
2. What is the central trade-off of a narrow network?
Both the benefit and the cost are real, and network adequacy on paper does not always mean practical access.
3. What does evidence suggest about financial protection from MA supplemental benefits?
The benefits are real but thinner than marketed, and no standardized quality measures exist to compare them.