Maine residents should be paying attention to a little-known Centers for Medicare & Medicaid Services (CMS) initiative that could quietly change how traditional Medicare works.

On Jan. 1, 2026, CMS is rolling out a program that would allow private companies — many with ties to Medicare Advantage — to decide whether care in traditional Medicare is “necessary,” often using AI-automated prior-approval systems. These companies make more money when care is delayed, denied and litigated, which is why Medicare Advantage has long been criticized for coverage denials.

The CMS describes this as a limited pilot. But under existing authority, it could be expanded nationwide without a vote in Congress and with minimal public visibility. A pilot can quickly become policy.

This matters in Maine. We have one of the highest proportions of older residents in the country. In places like Lincoln County, nearly one-third of residents are already old enough to qualify for Medicare, with others qualifying through disability or serious illness.

But this isn’t only an issue for current seniors. If this becomes the permanent way Medicare operates, everyone will eventually be subject to it — because most of us either rely on Medicare now or will depend on it later in life.

Traditional Medicare has worked because it is public, predictable and not driven by profit. Turning coverage decisions over to private gatekeepers risks undermining what still works.

Maine’s members of Congress should be asking hard questions now, before this becomes permanent.

Thomas Grosman
Bristol