Medicare Advantage insurers made almost 53 million prior authorization decisions in 2024, according to a Jan. 28 KFF analysis.
KFF relied on insurer data reported to CMS, focusing on service determinations, not claims determinations for services already provided. Withdrawn and dismissed determinations were excluded.
Prior authorization has now come to traditional Medicare in some states through a pilot program in 2026. MA insights could serve as a reference point while CMS assesses the program’s viability.
Here are six things to know about MA prior authorizations:
1. The number of prior authorizations decisions increased from 49.8 million in 2023, reflecting greater MA enrollment.
2. However, there was a slight decrease in prior authorization requests per enrollee. Enrollees averaged 1.7 requests in 2024 versus 1.8 in 2023.
3. MA insurers either fully or partially denied 4.1 million requests in 2024, a 7.7% share of all requests. This share was up from 6.4% in 2023 but in line with 2022’s 7.4%.
4. Only a fraction of denied requests were appealed (11.5%), while 80.7% of those were at least partially overturned.
5. Elevance and Centene saw the most prior authorization requests per enrollee in 2024 — 3.0 and 2.9 requests, respectively.
6. While UnitedHealth denied the greatest share of requests, Elevance denied the fewest: 12.8% versus 4.2%, respectively.
