A January 28, 2025 KFF report on Medicare Advantage (MA) assessing data from the Centers for Medicare and Medicaid Services (CMS) shows that in 2023 in aggregate MA prior authorizations were up (50 million), partial or full denials were down slightly (6.4%), only 11.7% of denials were appealed but more than 80% of the appeals were partially or fully overturned. This would suggest that beneficiaries should appeal partial or full denials of coverage by their MA plans.

The report points out that between 2020 and 2023 the number of prior authorizations increased 28%, which may explain why providers have been more vocal about the administrative burden of working with MA plans.

While the report suggests that denial rates have dropped slightly, this is in aggregate. However. the Senate “Refusal of Recovery” report, released October 17, 2024, showed that the denial rates can differ considerably when examined by service type and/or plan with denial rates for inpatient post-acute care services, like skilled nursing facility care, as much as 16 times higher than other services.  In contrast, home health service denials declined but MA plans achieved savings instead by clamping down on the number and types of visits they approved.

According to the KFF report, Humana and Anthem had the highest rate of prior authorizations but Centene led the pack in the rate at which prior authorizations were denied–13.6%  in comparison to the 6.4% average -and in the rate of denials overturned on appeal (93.6%),