The WISeR (Wasteful and Inappropriate Service Reduction) model is a CMS pilot program running 2026–2031 in six states. It requires prior authorization for 17 specific Medicare services before they are covered. A prior authorization request that is approved results in full Medicare coverage - a Medigap plan still covers your cost-share once care is approved.

State	Pilot Start	Pilot End	Innovative Plan G Available?
Arizona (AZ)	January 2026	December 2031	✅ Yes
New Jersey (NJ)	January 2026	December 2031	✅ Yes
Ohio (OH)	January 2026	December 2031	✅ Yes
Oklahoma (OK)	January 2026	December 2031	✅ Yes
Texas (TX)	January 2026	December 2031	✅ Yes
Washington (WA)	January 2026	December 2031	✅ Yes

What is Prior Authorization?

Your provider must submit a request to Medicare before performing one of the 17 covered service types. Medicare reviews the request and approves or denies it - typically within a few business days for standard requests. Emergency care is never delayed for prior authorization.

What is Innovative Plan G?

Innovative Plan G is a new Medigap plan type available exclusively in the six WISeR states. It provides all the coverage of standard Plan G plus additional benefits designed to support the prior authorization process - such as care coordination and case management services. Not all carriers offer it yet; contact us for quotes from carriers writing Innovative Plan G in your state.