Medicare Advantage
Medicare Advantage Plans Denied 65 Percent of Long-Term Acute Care Requests in 2024, KFF Finds
A KFF analysis of federal data finds Medicare Advantage insurers reject prior authorization requests for the most intensive post-acute care at rates that dwarf their overall denial average, and high appeal overturn rates suggest many initial decisions were not warranted.
By the Goodsurance editorial teamJuly 7, 2026
Medicare Advantage insurers denied 65 percent of prior authorization requests for long-term acute care hospital stays and 54 percent of requests for inpatient rehabilitation facility stays in June 2024, far above the overall Medicare Advantage prior authorization denial rate of less than 8 percent for all services, according to a KFF analysis released July 6, 2026.
Skilled nursing facility requests were denied at a 12 percent rate, still above the all-service average. Disparities widened further at the appeals stage. When patients or providers challenged denials, Medicare Advantage organizations reversed 36 percent of long-term acute care hospital decisions and 43 percent of inpatient rehabilitation decisions on appeal. For skilled nursing facility denials that reached appeal, plans reversed course 95 percent of the time.
Medicare Advantage denied 65 percent of long-term acute care requests in 2024. Patients who appealed won back about half those denials.
The three largest Medicare Advantage organizations by enrollment denied long-term acute care hospital requests at rates exceeding 70 percent, among the highest across the industry. The KFF analysis draws on two data briefs from the Office of Inspector General published in June 2026.
Post-acute care settings serve patients recovering from surgery, stroke, fractures, or serious illness. Denial or delay of admission to those facilities after a hospital stay can significantly affect recovery outcomes and can push families to manage complex care needs at home without clinical support.
CMS has taken steps to speed and standardize prior authorization, but the data show that as of mid-2024 denial rates for the most clinically intensive post-acute settings remained high relative to other services.
In plain words
When you are in a Medicare Advantage plan and your doctor wants to send you to a rehab hospital or long-term care hospital, your plan must say yes first. This is called prior authorization. A new study found that plans said no to more than half of those requests in 2024. That is much higher than how often they say no to other kinds of care. When patients fought those decisions, they usually won for nursing home care and about half the time for other rehab. Fighting takes time and effort, and many people never try.
Understand the basics first
Source: KFF
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