Prior authorization and Medicare Advantage: 5 numbers to know

Medicare Advantage plans fully or partially denied around 6 percent of prior authorization claims in 2021, according to an analysis from Kaiser Family Foundation published Feb. 2. 

KFF analyzed data for 515 MA contracts in 2021, accounting for 87 percent of the program's enrollees. 

Here are 5 numbers to know about prior authorization in Medicare Advantage: 

  1. In 2021, there were 35.2 million prior authorization requests submitted for MA enrollees, accounting for an average of 1.5 requests per enrollee. 

  2. The rate of requests varied by payer. Elevance Health (Anthem) plans had an average of 2.9 requests per member, while Kaiser Permanente had 0.3 requests per member. 

  3. Of the 35.2 million requests submitted, 2 million were denied, around 6 percent of total requests.

  4. Eleven percent of prior authorization denials in Medicare Advantage plans were appealed. 

  5. Of the denials that were appealed, 82 percent were fully or partially overturned. 

Read more here. 

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