Dual-eligible special needs plan enrollees are twice as likely to have prior authorization requests denied compared to all other Medicare Advantage members, according to KFF.
According to the analysis, D-SNP carriers received nearly 670,000 prior authorization requests in 2021, which saw a 12% denial rate. The same year, all Medicare Advantage plans (which includes D-SNPs), saw a prior authorization denial rate of 6%.
Among individual insurers, CVS and Centene had a D-SNP prior auth denial rate of 15%, UnitedHealthcare had 13%, BCBS had 11% and Humana had 5%.
In 2021, D-SNPs plans received one prior authorization request per member on average, compared to 1.5 requests per member for all MA plans, according to the analysis.
In 2023, 5.2 million people were enrolled in D-SNP plans.