A new analysis from independent research organization the Kaiser Family Foundation (KFF) provides fresh evidence of the challenges that prior authorization (PA) requirements can create for Medicare Advantage (MA) enrollees and also highlights the continued need for congressional action to improve transparency and accountability in the program.

The August 13, 2026 report comes as Congress considers the Improving Seniors’ Timely Access to Care Act (HR 3514/S 1816), bipartisan legislation that LeadingAge has long supported. The bill seeks to modernize and streamline the MA PA process while increasing oversight of how plans use PA tools to make coverage decisions.

KFF analyzed newly available PA data reported by major insurers under a 2024 Centers for Medicare and Medicaid Services (CMS) rule requiring health plans to publicly disclose information on approval rates, denial rates, and response times.

The first round, covering 2025, was due at the end of March 2026 and includes 14 companies covering about 71 million people.

According to KFF’s analysis of that data, denial rates for standard prior authorization requests in 2025 were:

• 12% for MA plans
• 14% in Medicaid managed care
• 18% in Affordable Care Act (ACA) Marketplace plans

Notably, while relatively few denials were appealed, 67% of MA denials that were appealed were ultimately overturned, compared to 47% in Medicaid managed care and 43% in ACA exchange plans. These figures raise serious questions about whether many requests should have been approved from the beginning.

For beneficiaries, delayed approvals can mean delayed access to medically necessary services. For providers, prior authorization requirements often create significant administrative burdens and uncertainty around care planning.

Despite the new reporting requirements, KFF found substantial limitations in the available data. Insurers reported information using different formats, making direct comparison of plans difficult. The data also do not consistently include actual numbers of requests and denials, and they provide limited insight into the types of services being denied. As a result, patients, providers, and policymakers still face challenges in understanding how prior authorization policies affect access to care across plans.

CMS has proposed additional reporting improvements for future years, but KFF notes that more comprehensive and standardized data will be necessary to fully evaluate insurer practices.

The report specifically identifies the Improving Seniors’ Timely Access to Care Act as one potential avenue for strengthening transparency. The legislation would require MA plans to submit additional prior authorization data to the Department of Health and Human Services for public reporting, including information about the use of artificial intelligence and other automated tools in coverage determinations.

The release of the report comes at a noteworthy moment for the legislation. The House Ways and Means Committee on July 15, 2026 approved the Improving Seniors’ Timely Access to Care Act and the House Energy and Commerce Committee advanced the bill on July 21 as part of a broader health care transparency package. Both committees approved the legislation unanimously, reflecting broad bipartisan concern about MA PA practices.

LeadingAge endorsed the legislation and will continue working with congressional champions, coalition partners, and other stakeholders to support passage of this effort improve transparency, accountability, and timely access to care for Medicare beneficiaries.