How often do Medicare Advantage deny rehab care?

Denials for skilled nursing and rehab requests

Two related federal investigations and analysis pieces found that Medicare Advantage insurers commonly deny requests for post-acute rehabilitation and skilled nursing facility care—then sometimes reverse those denials after an appeals process.

One analysis reported that insurers denied about 13% of patients’ requests to go to a skilled nursing facility to recover. Another set of reporting described a broader pattern: dominant Medicare Advantage plans were said to deny rehabilitative care at higher rates than other industry peers, and then frequently overturn those decisions later.

What the investigation focused on

The coverage centers on utilization management—the prior authorization and review steps that determine whether an older adult or disabled person can access rehab or skilled nursing services. In these reports, the denial decisions were not isolated incidents; they reflected consistently high denial behavior across multiple requests.

Why it matters

For patients and caregivers, the key consequence is timing. Rehab and skilled nursing are often needed soon after a hospitalization or medical event, and delays caused by denials and appeals can interrupt recovery.

At the system level, the findings raise questions about whether Medicare Advantage plan structures—especially incentives tied to cost control—translate into access barriers for people who need skilled recovery services.

The reported pattern of denials followed by later reversals also matters for healthcare planning and trust: patients may spend time navigating appeals even when coverage is ultimately granted. For policymakers, the results strengthen the case for closer oversight of prior authorization practices and appeal turnaround.