Medicare Advantage Plans Reject Nearly 1 in 5 Prior Authorization Requests

A recent study by KFF found that Medicare Advantage plans denied between 12% and 18% of standard prior authorization requests in 2025. This can cause delays or denials for patients receiving necessary care, as well as administrative burdens for providers.

The six largest Medicare Advantage insurers included in the analysis had standard-request denial rates ranging from 5% at Elevance to 17% at UnitedHealth Group. Expedited-request denial rates varied from 3% at Elevance to 13% at Centene.

Appeals are often successful, with 67% of appealed standard-request denials being overturned in Medicare Advantage. However, the metrics were aggregated across medical items and services, making it difficult to determine which service categories had the highest prior authorization denial rates.