How high are Medicare Advantage prior auth denials?

HHS inspector general report highlights unusually high denials

A federal HHS report found that Medicare Advantage plans denied prior authorization requests for long-term care at unusually high rates. The report singled out UnitedHealthcare, CVS Health, and Humana as having the highest denial rates for long-term care requests.

What kind of requests were denied

The coverage focused on long-term care authorization decisions, which commonly include services needed after hospitalization or for ongoing support. Prior authorization is the gatekeeping step where plans require documentation and approval before care is provided.

The associated analysis also described how denial behavior can affect access to skilled nursing facility recovery and rehabilitative care, with some denials later overturned through appeals.

Why it matters

For patients and families, a prior authorization denial can mean delays in receiving needed care—particularly for older adults and people with disabilities who may require skilled recovery services soon after an acute episode.

At the policy level, high denial rates raise concerns about whether plan utilization management practices are functioning primarily as cost control rather than as medically necessary decision-making.

For the health system, repeated denials and appeals can add administrative burden for providers and force patients to navigate complex processes while trying to recover.

Overall, the findings provide fresh evidence that regulators and oversight bodies may need to examine not only the medical appropriateness of decisions, but also the patterns of denial and the time it takes to resolve disputes—factors that can translate into real-world access gaps.