Call to Action: KFF Prior Auth Analysis Shows Low Rates of Appeal Following Denial
by ACOI
February 17, 2026
A new analysis by KFF found Medicare Advantage insurers processed 52.8 million prior authorization requests in 2024. Of those requests, 4.1 million requests were either fully or partially denied. A majority (80.7%) of denials were overturned on appeal; although only 11.5 percent of denials were appealed.
Most insurers that had more prior authorization requests per enrollee than average denied a smaller share of those requests, such as Elevance Health, which had 3.0 prior authorization requests per enrollee and a denial rate of 4.2 percent. UnitedHealth Group, which had among the lowest prior authorization requests per enrollee (1.0), had the highest denial rate at 12.8 percent. Centene was an exception which had a high number of prior authorization requests per enrollee (2.9) and a relatively high denial rate (12.3%).
In June 2025, some of the biggest insurers pledged to improve prior authorization processes, including by reducing the volume of medical services subject to prior authorization by January 1, 2026.
According to the KFF analysis, there has been an increase in the total number of prior authorization requests since 2020, but the increase corresponds to growth in MA enrollment. Therefore, the number of prior authorization requests per enrollee has remained relatively constant in the past few years. In 2024, MA enrollment growth outpaced the increase in the number of prior authorization requests, leading to a slight drop in the number of requests per enrollee to 1.7.
Lawmakers in Congress have introduced legislation aimed at reforming prior authorization processes, including the Improving Senior’s Timely Access to Care Act (S. 1816 and H.R. 3514) which codifies and expands upon prior authorization changes for MA plans made through recent rulemaking. ACOI endorses this bill and encourages its members to contact congressional lawmakers and ask for support. Take action through the ACOI Action Center.