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:
- In 2021, there were 35.2 million prior authorization requests submitted for MA enrollees, accounting for an average of 1.5 requests per enrollee.
- 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.
- Of the 35.2 million requests submitted, 2 million were denied, around 6 percent of total requests.
- Eleven percent of prior authorization denials in Medicare Advantage plans were appealed.
- Of the denials that were appealed, 82 percent were fully or partially overturned.
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