A KFF analysis of newly public 2025 federal data reveals that health insurers denied at least 1 in 8 standard prior authorization requests across Medicare Advantage, Medicaid, and ACA marketplace plans. Average denial rates ranged from 12% to 18%, with significant variation among individual insurers—such as Centene denying 25% of ACA requests while Elevance denied just 5% in Medicare Advantage. Although up to 67% of appealed denials were overturned, very few patients actually appeal initial decisions.
Prior authorization denial rates
- ▪A KFF analysis of 2025 federal data found that health insurers denied at least 1 in 8 standard prior authorization requests across Medicare Advantage, Medicaid managed care, and Affordable Care Act marketplace plans.
- ▪The KFF analysis found that average standard prior authorization denial rates in 2025 were 12% in Medicare Advantage, 14% in Medicaid managed care, and 18% in the Affordable Care Act marketplaces.
Insurer-to-insurer variation
- ▪In Medicaid managed care plans, standard prior authorization denial rates in 2025 ranged from 2% for L.A. Care Health Plan to 23% for Independence Health Group.
- ▪In the Affordable Care Act marketplaces, standard prior authorization denial rates in 2025 ranged from 3% for GuideWell to 25% for Centene.
- ▪In Medicare Advantage plans, standard prior authorization denial rates in 2025 ranged from 5% for Elevance to 17% for UnitedHealth Group.
Appeals success rates
- ▪The KFF analysis showed that 67% of Medicare Advantage prior authorization denials were overturned upon appeal.
- ▪The KFF analysis showed that 47% of Medicaid managed care denials and 43% of Affordable Care Act marketplace denials were overturned upon appeal.
CMS transparency requirements
- ▪The KFF noted that the public data had gaps, including inconsistent reporting formats and a lack of total request volumes or service-type breakdowns.
- ▪The KFF analysis was based on new federal prior authorization data that insurers were required to publish for the first time in 2026 under Centers for Medicare & Medicaid Services transparency rules.
Industry reform commitments
- ▪Major health insurers pledged to the Trump administration to pare back onerous prior authorization policies, reporting an 11% reduction in prior authorizations as of April 2026.
- ▪America's Health Insurance Plans stated that the KFF data confirms the vast majority of prior authorization requests are approved and responded to in less than one day.
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