| Course | SWG 573 Policies to Promote Healthy Aging |
|---|---|
| Module | Module 7 |
| Paper type | Policy analysis paper |
| Length | About 905 words, 6 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | Master of Social Work |
| Updated | October 2026 |
Free sample paper for SWG 573 Module 7
Care Delayed: Medicare Advantage Prior Authorization and the Older Adults It Affects
Student Name
Master of Social Work, Arizona State University
SWG 573: Policies to Promote Healthy Aging
Instructor Name
Month Day, Year
Care Delayed: Medicare Advantage Prior Authorization and the Older Adults It Affects
Introduction
More than half of eligible Medicare beneficiaries now receive their benefits through private Medicare Advantage plans: 35.2 million people in 2026, or 55% of beneficiaries eligible to enroll, up from 19% of eligible beneficiaries in 2007 (Freed et al., 2026). As enrollment has grown, so has concern that the plans' use of prior authorization, the requirement that a plan approve a service before it is delivered, delays or denies care older adults need. This paper examines that problem and analyzes the Medicare Advantage program and the federal rules that govern its prior authorization practices.
The Social Problem
The problem is older adults' delayed or denied access to medically necessary care. A federal investigation of a sample of Medicare Advantage prior authorization denials found that 13% of them met Medicare coverage rules, meaning the services would likely have been approved under traditional Medicare; 18% of sampled payment denials also met coverage and billing rules (U.S. Department of Health and Human Services, Office of Inspector General, 2022). Denied services included advanced imaging and stays in post-acute facilities after hospitalization.
The causes are systemic. Medicare Advantage plans are paid a fixed amount per enrollee, which creates a financial incentive to manage the use of services. The investigation found that plans sometimes applied internal clinical criteria stricter than Medicare's own rules and denied requests for insufficient documentation when the records were adequate. Many older adults do not know they can appeal a denial.
Some groups are affected more than others. People with multiple chronic conditions and those leaving the hospital need more services and face more authorization requests. Adults with cognitive impairment, limited English or low health literacy, and those without family advocates, are least able to navigate appeals. People dually eligible for Medicare and Medicaid, who are often low-income and disabled, are increasingly enrolled in Medicare Advantage special needs plans.
The Policy: Objectives, History and Development
Medicare Advantage aims to give beneficiaries a choice of private plans that coordinate care and often offer extra benefits, while giving the government more predictable costs. Its roots lie in the risk contracts with private health plans authorized in the early 1980s. The Balanced Budget Act of 1997 renamed the program Medicare+Choice, and the Medicare Modernization Act of 2003 renamed it Medicare Advantage and increased payments, which helped enrollment grow.
Prior authorization developed as a standard managed care tool. In response to concerns, the Centers for Medicare & Medicaid Services issued a rule in 2023 requiring plans, starting in 2024, to follow traditional Medicare's national and local coverage determinations, to base any internal criteria on publicly available evidence, to keep prior authorization approvals valid for as long as medically necessary, to allow a 90-day transition period for new enrollees in active treatment and to form utilization management committees to review policies annually (Centers for Medicare & Medicaid Services, 2023). A 2024 rule added decision deadlines, beginning in 2026, of 72 hours for urgent requests and seven calendar days for standard ones, required a specific reason for every denial and required plans to post prior authorization metrics publicly (Centers for Medicare & Medicaid Services, 2024).
Support and Opposition
Supporters, including insurers and many enrollees, point to lower premiums, supplemental coverage that traditional Medicare lacks and coordinated care. They argue that prior authorization prevents unnecessary or unsafe services. Critics, including physician groups, hospitals and advocates for older adults, argue that prior authorization creates delays and administrative burden and that payment incentives reward denials.
| Strengths | Weaknesses |
|---|---|
| Choice of plans and extra benefits | Denials of care that meets Medicare rules |
| Out-of-pocket maximum not found in traditional Medicare | Complex appeals few beneficiaries use |
| New federal rules on criteria and deadlines | Enforcement depends on oversight capacity |
| Public reporting of authorization metrics from 2026 | Narrow networks in some areas |
Impact on the Problem, At-Risk Populations and Social Work
The 2023 and 2024 rules address the main causes identified by the investigation: criteria stricter than Medicare's, slow decisions and unexplained denials. Their impact depends on enforcement and on whether beneficiaries know their rights. For at-risk populations, a seven-day standard decision can still delay a discharge or a post-acute admission.
For social workers, the policy shapes daily practice. Hospital social workers and discharge planners arrange post-acute care and often spend hours obtaining authorizations, while community social workers help clients understand plan choices and file appeals. The NASW Code of Ethics calls on social workers to advocate for policies that ensure access to needed resources (National Association of Social Workers, 2021), which makes appeals support and policy advocacy part of the professional role.
Recommendations
First, CMS should audit plans' compliance with the coverage criteria rule and publish the results, with penalties for repeated improper denials. Second, plans should be required to report denial and overturn rates by service type, so patterns such as post-acute denials are visible. Third, states and Area Agencies on Aging should fund appeal assistance through State Health Insurance Assistance Programs, prioritizing people with cognitive impairment or limited English. Fourth, social work programs should teach Medicare appeals as a core skill in gerontology practice.
Conclusion
Medicare Advantage offers choice and benefits that many older adults value, but prior authorization has produced denials of care that traditional Medicare would cover. Recent federal rules target the causes, and their success will depend on enforcement, transparency and the advocacy of social workers who help older adults use their rights.
References
Centers for Medicare & Medicaid Services. (2023, April 5). 2024 Medicare Advantage and Part D final rule (CMS-4201-F) [Fact sheet]. https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f
Centers for Medicare & Medicaid Services. (2024, January 17). CMS interoperability and prior authorization final rule (CMS-0057-F) [Fact sheet]. https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f
Freed, M., Fuglesten Biniek, J., Damico, A., Ochieng, N., & Neuman, T. (2026). Medicare Advantage in 2026: Enrollment update and key trends. KFF. https://www.kff.org/medicare/medicare-advantage-enrollment-update-and-key-trends/
National Association of Social Workers. (2021). Code of ethics of the National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
U.S. Department of Health and Human Services, Office of Inspector General. (2022). Some Medicare Advantage organization denials of prior authorization requests raise concerns about beneficiary access to medically necessary care (OEI-09-18-00260). https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp
What the SWG 573 Module 7 instructions ask for
The Policy Paper is the final assignment in SWG 573, worth 40 points and due at the end of Week 7, Module 7. Select a public policy affecting older adults that interests you; the syllabus suggests options such as Medicare, the Elder Justice Act, the Medicare Advantage program, PACE, respite care, the Older Americans Act and Social Security. Using research literature, define the related social problem, explore its systemic causes and identify disproportionately affected populations. Then analyze the policy's objectives, history, development, support and opposition, strengths and weaknesses and its impact on the problem, at-risk populations and the social work profession, and close with evidence-informed recommendations. Follow APA 7, and see the Canvas instructions for details.
How this SWG 573 Module 7 example is built
The sample opens with current enrollment data and defines prior authorization in plain words. The problem section uses a federal investigation to show the scale of improper denials, then explains systemic causes and names the populations most affected. The policy section traces the program's history and summarizes two recent federal rules with dates and requirements. Support and opposition are presented fairly, and a table lists strengths and weaknesses. The impact section addresses the problem, at-risk groups and social work specifically. Four recommendations follow from the weaknesses identified. Margin notes explain how the structure follows the prompt. Every figure comes from a federal report, a federal rule or a nonpartisan research organization.
Where the marks sit in the SWG 573 Module 7 rubric
Graders assessing the 40-point policy paper look for a clearly defined social problem supported by research, accurate analysis of the policy's objectives, history and development, a balanced account of support and opposition, a fair assessment of strengths and weaknesses and specific attention to at-risk populations and the social work profession. Papers lose points when the problem is vague, when history is incomplete or inaccurate, when only one side of the debate appears or when the recommendations are disconnected from the weaknesses identified. Current data and primary sources, such as federal reports and rules, strengthen the paper, as do correct APA format and clear organization. Recommendations that name who should act, and how, usually score higher.
SWG 573 Module 7 help with common mistakes
Choose a policy where you can find recent federal reports and data. Define the social problem in one sentence before you research. Use headings that match each element the prompt lists. Present support and opposition fairly, with sources for each. Use a table for strengths and weaknesses. Explain how the policy affects social workers' daily tasks. Make each recommendation answer a weakness you identified. If the policy history feels tangled, the desk can help you build a timeline. Check that all figures are current. Read the federal rule's fact sheet directly rather than relying on news summaries. Keep the history section brief and focused on changes that matter for your problem.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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SWG 573 Module 7 questions, answered
Where can I find a free SWG 573 Module 7 sample paper?
The full policy paper on Medicare Advantage prior authorization is on this page.
What does the SWG 573 policy paper require?
A social problem affecting older adults and an analysis of a related policy, with recommendations.
How many people are in Medicare Advantage?
35.2 million in 2026, 55% of eligible beneficiaries, according to KFF.
How often were Medicare Advantage prior authorization denials improper?
A federal review found 13% of sampled denials met Medicare coverage rules.
What did the 2024 CMS prior authorization rule require?
Decisions within 72 hours for urgent and seven days for standard requests, starting in 2026, with specific denial reasons.