AI ‘Death Panels’ Could Soon Decide Your Medicare Coverage Under Trump Plan

When Medicare starts using artificial intelligence to decide which medical treatments get approved, millions of seniors could face a new reality where computers help determine their healthcare access. The federal government plans to launch the WISeR model in January 2026, testing AI-driven prior authorization for certain procedures across six states.

This pilot program excludes emergency services, inpatient-only procedures, and treatments where delays could harm patients. However, critics worry about the financial structure behind these AI systems. Outside companies running the WISeR pilot get paid based on how much money they save by denying claims. This payment model incentivizes maximizing denials, potentially putting necessary treatments at risk.

The concerns aren’t theoretical. Senate investigations found that major insurance carriers like CVS and United Healthcare already use AI to deny post-acute care in Medicare Advantage programs. Documents revealed these companies had financial motives for using AI systems to limit care access. Some AI systems produce denial rates up to 16 times higher than typical review processes.

Medicare’s push toward AI comes as the program spent up to $5.8 billion in 2022 on unnecessary or inappropriate services. Contractors now use AI tools to flag claims for services they consider vulnerable to fraud and abuse. While stopping waste matters, experts warn that poorly designed financial incentives could harm patients through excessive denials.

Congress is considering the Health Tech Investment Act, which would create new Medicare reimbursement pathways for AI-enabled healthcare services. The legislation introduced by Senators Mike Rounds and Martin Heinrich would establish a new technology APC for algorithm-based healthcare services from FDA-cleared devices. Over 600 FDA-approved AI medical devices currently lack predictable Medicare reimbursement, limiting patient access to these technologies. The bill proposes transitional reimbursement for at least five years while collecting data to set permanent payment rates. The lack of clear billing codes has created unpredictable reimbursement pathways that prevent many innovative technologies from reaching patients who need them.

AI technology has shown promise in healthcare, particularly in radiology where it’s improved diagnosis speed and accuracy. But without proper oversight and transparent data on delays and denials, patients can’t know how these systems affect their care.

Critics emphasize that for-profit vendors have historically placed cost savings above appropriate patient care. They’re calling for CMS to release timely public reporting on how AI decisions impact Medicare beneficiaries’ access to treatments.