Analysis Examines Denials of Prior Authorization Requests Across Markets and By Insurer

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Insurers denied at least 1 in 8 standard requests for prior authorization in 2025 across three major markets – Medicare Advantage (12%), Medicaid managed care (14%), and the Affordable Care Act Marketplaces (18%), finds a new KFF analysis of publicly available data.

Insurers require prior authorization for certain procedures and treatments as a way to reduce unnecessary care and contain costs. The practice has received increased attention in recent years as it can lead to delays or denials in receiving care and creates administrative burdens for patients and providers.

KFF’s analysis examines data about insurers’ prior authorization use that plans are required to post publicly as part of a 2024 final rule from the Centers for Medicare and Medicaid Services aimed at streamlining and automating the prior authorization process. The analysis assessed data from 14 large insurers with the largest enrollment in each market.

Among Medicare Advantage insurers, the denial rate for standard requests ranged from 5% for Elevance to 17% for United Health Group. In Medicaid Managed Care, the range went from 2% for L.A. Care Health Plan to 23% for Independence Health Group. In the ACA Marketplace, the range went from 3% for GuideWell to 25% for Centene.

Other findings include:

  • When prior authorization denials are appealed, the original decision is often overturned across the three markets – two-thirds (67%) of the time in the Medicare Advantage market, nearly half (47%) of the time for Medicaid managed care, and 43% of the time in the ACA Marketplaces.
  • Median response times in all markets were about one day for standard prior authorization requests. For expedited requests, the typical response time was half a day for Medicare Advantage and about a day for Medicaid managed care and the ACA Marketplace.  The short median response times may stem from the growing use of artificial intelligence and electronic systems to help process requests.

The analysis also highlights several limitations in the publicly reported data that reduce their usefulness for consumers.