New Mandatory Medicare Advantage Prior Authorization Data Shows About 12 Percent of Standard Requests Were Denied in 2025

For the first time, Medicare Advantage organizations were required to publicly post detailed prior authorization metrics for the 2025 calendar year, alongside similar requirements for Medicaid managed care plans and Affordable Care Act marketplace insurers. Payers had until March 31, 2026 to post their data.

A KFF analysis of the newly available information found that, for Medicare Advantage plans specifically, about 12 percent of standard prior authorization requests were denied in 2025, and about 10 percent of expedited requests were denied. Response times were generally fast: the median time to a standard determination in Medicare Advantage was about 0.9 days, well under the federally permitted maximum.

Variation across plans was considerable. Among six large Medicare Advantage organizations examined, denial rates for standard requests ranged from 5 percent at Elevance to 17 percent at UnitedHealth Group.

KFF identified significant limits in what the data can reveal. Because the metrics are aggregated across all items and services with no breakdown by type of care, it is difficult to determine which services are most frequently denied or to compare insurer behavior in specific clinical areas. Insurers are also not required to report the reasons a request was denied, leaving patients and researchers with limited insight into what drives the numbers.

CMS updated its prior authorization metrics reporting template in July 2026, requiring states to begin collecting and reporting prior authorization metrics from Medicaid managed care plans in their annual reports to the agency. KFF said the updated requirements address some of the gaps in the current data and should produce more granular reporting in future cycles.