Insurer Denials High In Medicare Advantage, Medicaid And Obamacare, Report Says

Health insurers denied “at slightest 1 successful 8 modular requests” erstwhile anterior authorization was required crossed Medicare Advantage, Medicaid and Obamacare plans past year, KFF said successful an study published August 13, 2026.

getty

Health security companies denied “at slightest 1 successful 8 modular requests” erstwhile anterior authorization of treatments and procedures was required crossed the largest categories of government-subsidized wellness security past year.

A caller study by KFF shows that insurers denied betwixt 12% and 18% of anterior authorization requests past twelvemonth for Americans enrolled successful either privatized Medicare Advantage sum for older adults, Medicaid sum for mediocre Americans aliases individual sum nether the Affordable Care Act, besides known arsenic Obamacare.

The study comes astatine a clip wellness security business practices are nether occurrence from patients, physicians, lawmakers and regulators astatine some the authorities and national level to trim aliases get free of anterior authorization, the process of insurers reviewing infirmary admissions and medications.

“Medicare Advantage insurers denied 12% of modular anterior authorization requests, Medicaid managed attraction insurers denied 14%, and ACA Marketplace insurers denied 18%,” KFF said successful its study of information that insurers were required to people earlier this twelvemonth nether caller regulations by the Centers for Medicare & Medicaid Services.

“Among Medicare Advantage insurers, the denial complaint for modular requests ranged from 5% for Elevance to 17% for United Health Group,” KFF said successful its analysis. “In Medicaid Managed Care, the scope went from 2% for L.A. Care Health Plan to 23% for Independence Health Group. In the ACA Marketplace, the scope went from 3% for GuideWell to 25% for Centene.”

But galore of these wellness insurers person since made reforms to their anterior authorization and successful immoderate cases have eliminated it altogether since past year. And a twelvemonth ago, the biggest names successful wellness insurance, including Centene, Cigna, CVS Health’s Aetna, UnitedHealth Group’s UnitedHealthcare and Humana were among much than 50 wellness insurers committing to reducing anterior authorization on pinch simplifying business practices successful general.

The KFF study said anterior authorization denials are seldom appealed, “but erstwhile they are, a sizeable stock are overturned,” the study showed. “Sixty-seven percent of anterior authorization denials were overturned upon entreaty successful Medicare Advantage, 47% were overturned upon entreaty successful Medicaid managed care, and 43% were overturned successful the ACA federally facilitated Marketplace.”