A new analysis from KFF shows that health insurers denied at least one in eight standard prior authorization requests last year across the nation’s major government-subsidized health insurance programs—Medicare Advantage, Medicaid, and Affordable Care Act (ACA) Marketplace plans. The denial rates ranged from 12% for Medicare Advantage to 18% for ACA Marketplace coverage, with notable variation among individual insurers, according to the KFF report.
For Medicare Advantage, the share of standard prior authorization requests denied by the largest insurers ranged from 5% at Elevance to 17% at UnitedHealth Group. In Medicaid managed care, denial rates ranged from 2% for L.A. Care Health Plan to 23% for Independence Health Group. In ACA Marketplace plans, denial rates for standard requests ranged from 3% at GuideWell to 25% at Centene. Across all three types of plans, expedited requests—which are considered urgent—were denied at similar or slightly lower rates than standard requests.
The federal government now requires insurers to publish these prior authorization figures as part of a push for greater transparency and accountability. The Centers for Medicare and Medicaid Services (CMS) began mandating public reporting of these metrics in 2026 as part of new regulations designed to help consumers and policymakers better understand insurer practices and improve access to care.
While most prior authorization requests were approved—ranging from 82% to 90% depending on the plan type—a significant share of denied requests were later overturned on appeal. The KFF analysis found that 67% of denials in Medicare Advantage, 47% in Medicaid managed care, and 43% in ACA Marketplace plans were overturned when appealed, although appeals remain rare. According to insurers and industry groups like America’s Health Insurance Plans (AHIP), most requests are now processed quickly, with median response times of about one day for standard requests—much faster than the federally required 14- or 15-day maximums.
The use of ai-assisted tools and electronic systems is helping speed up the process, but some patients still report delays or difficulty securing needed care. About 24% of insured adults said their coverage delayed needed treatment in the last two years, according to a July 2025 KFF poll.
Denial rates also varied by service type. For example, Medicare Advantage plans denied more than half of prior authorization requests for expensive post-acute care, such as long-term care hospital stays (65%) and inpatient rehabilitation (54%), which is much higher than the overall denial rate for all services. When these denials were appealed, most were eventually approved, especially for skilled nursing facility stays.
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