Medicare Advantage Articles & Sources
Are you or a family member exploring the choices for Medicare coverage? The articles below provide more information about Traditional Medicare, Medicare Advantage, and the risks you can face when enrolling or making a change.
- MA insurers denied 3.2 million, or 6.4%, of prior authorization requests in 2023.
- The percentage of denied prior authorization requests declined from 2022, when MA insurers denied 7.4% of requests that year.
- The majority of denied prior authorization requests were not appealed. In 2023, 11.7% of denied requests were appealed.
- The share of denied requests that were appealed increased since 2019, when 7.5% of denied requests were appealed.
- In 2023, more than 4 in 5 prior authorizations that were denied were eventually approved after an appeal.
- The number of prior authorizations varied by insurer. Humana and Anthem had the highest rate of prior authorization determinations per beneficiary, at 3-to-1.
- Kaiser Permanente had the lowest, at 0.5 prior authorization determinations per beneficiary.
- The number of prior authorization denials also varied by insurer. Centene had the highest rate of denials, at 13.6%. Humana had the lowest rate, at 3.5%.
- Prior authorization is used for a small share of traditional Medicare services, and has increased over the past three years. In 2023, CMS completed 393,749 prior authorization reviews, up from around 261,000 in 2022.
- In 2023, CMS denied 28.8% of prior authorization requests in traditional Medicare.
- 3 Reasons Retirees Should Not Enroll in Medicare Advantage for 2025 (The Motley Fool)
- Uncovered: How the Insurance Industry Denies Coverage to Patients (ProPublica)
- “Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care (ProPublica)
- Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care (U.S. Senate Permanent Subcommittee on Investigations | October 2024)
- Former Insurance Executive Says: Older adults should avoid Medicare Advantage in 2025 (Becker’s Payer Issues)
- The Pros and Cons of Medicare Advantage (Consumer Reports)
- AMA Survey Indicates Prior Authorization Wreaks Havoc on Patient Care (American Medical Association)
- User of Prior Authorization in Medicare Advantage Exceeds 46 Million Requests in 2022 (Kaiser Family Foundation)
- Association of Medicare Advantage Enrollment With Financial Burden of Care (Annals of Family Medicine)
These materials are produced for educational purposes only.
