Managed Care
Medicare Advantage Plans Denied 12% of Prior Authorizations in 2025, KFF Finds
Medicare Advantage, Medicaid managed care, and ACA Marketplace plans denied between 12% and 18% of standard prior authorization requests in 2025, according to a KFF study. Denial rates varied widely among the largest insurers. The study highlights prior authorization burdens on providers, including home health agencies. The findings are current as of 2025 data.
Why it mattersThe study provides comparative benchmarking data that Medicaid managed care plans and state agencies can use to assess their own prior authorization denial rates and administrative burden relative to Medicare Advantage and marketplace plans.