Networks with Original Medicare and Prior Authorizations

Original Medicare in Texas (Parts A and B) offers nationwide coverage with any provider accepting Medicare, generally without prior authorization requirements. However, starting January 1, 2026, Texas is part of a 6-year federal pilot program requiring prior authorization for 17 specific, high-cost Part B services deemed vulnerable to fraud. [1, 2, 3, 4]
Original Medicare Networks & Rules in Texas
  • Provider Access: You can see any doctor, specialist, or hospital in the U.S. that accepts Medicare. There are no network restrictions.
  • Prior Authorization (Before 2026): Rare. Original Medicare typically does not require pre-approval for services, unlike Medicare Advantage plans, which require them for most services.
  • Prior Authorization (As of Jan 1, 2026): Texas is part of the Medicare WISeR Model pilot, meaning certain services (e.g., specific imaging, procedures) will require approval to avoid fraud, waste, and abuse.
  • Costs: You pay deductibles and a 20% coinsurance for most services, usually covered by a Medigap policy. [1, 2, 3, 4, 5]
Difference from Medicare Advantage in Texas
  • Networks: Medicare Advantage plans (offered by insurers like UnitedHealthcare, Humana, Aetna) restrict you to specific networks.
  • Prior Authorization: Almost all (99%) Medicare Advantage enrollees require prior authorization for services like inpatient stays or, scans, and treatments. [1, 2, 3]
For the most current list of services requiring authorization in 2026, check the official CMS website. [1]
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