Goodsurance

Medicare Advantage

KFF: Medicare Advantage Plans Deny Post-Acute Care Prior Authorization Requests at Rates Far Above the Overall Average

New KFF analysis of mandatory public data found that denial rates for nursing facility, home health, and rehabilitation requests in Medicare Advantage significantly exceed the program-wide average.

By the Goodsurance editorial teamSeptember 10, 2026

Medicare Advantage insurers received nearly 53 million prior authorization requests in 2024 and denied about 7.7 percent of them overall, according to KFF analysis of the first full year of public reporting data. But for post-acute care services such as skilled nursing facility stays, inpatient rehabilitation, and home health, denial rates ran substantially higher than that average, KFF found.

The data comes from a federal requirement, effective in 2024, that Medicare Advantage organizations publicly disclose their prior authorization volumes, denial rates, processing times, and appeal outcomes. KFF analyzed the first complete calendar year of submissions.

Medicare Advantage denies post-acute care requests at far higher rates than the program average, KFF found. Appeals reverse the decision 95% of the time.

Prior authorization requires a physician or other provider to get insurer approval before a service is delivered. Critics argue the process can delay or prevent care for seriously ill or recovering patients. A separate federal audit published in August 2026 found that when Medicare Advantage enrollees appealed nursing home prior authorization denials, plans reversed their decisions 95 percent of the time, suggesting many initial denials may not withstand review.

CMS has said Medicare Advantage plans cannot restrict public access to the required prior authorization data behind password-protected portals, following guidance issued in August 2026.

For Medicare beneficiaries who need post-acute care, the data underscores the importance of filing an appeal promptly if a Medicare Advantage plan denies coverage for a nursing home stay, rehabilitation program, or home health episode.

In plain words

Medicare Advantage plans have to say publicly how often they reject requests to pay for care. A study found they rejected about 8 out of 100 requests in 2024. But for nursing home stays and rehab care, the rejection rate was much higher. When patients fought those rejections, plans changed their minds 95 percent of the time. If your Medicare Advantage plan denies care after a hospital stay, you have the right to appeal.

Understand the basics first

Source: KFF
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