Rising Prior Authorization Requests in Medicare Advantage: Trends, Challenges, and Implications

In 2024, prior authorization requests within Medicare Advantage (MA) plans increased significantly, reaching nearly 53 million compared to about 50 million in 2023, according to a report by KFF. This rise reflects growing enrollment in MA plans. On average, beneficiaries had 1.7 authorization requests per year, slightly lower than the 1.8 requests recorded the previous year. Approximately 8% of these requests were either fully or partially denied.

Despite the denial rate, only 12% of rejected requests were appealed. However, more than 80% of appealed cases were ultimately approved, suggesting that many patients experience unnecessary delays in receiving care that is eventually granted. Prior authorization is commonly required for costly services such as chemotherapy or skilled nursing facility stays.

The practice remains controversial: insurers argue it helps control unnecessary healthcare spending, while providers claim it delays essential treatment and may negatively impact patient outcomes. Regulatory attention has increased, with efforts to reform prior authorization policies, including voluntary commitments from insurers to reduce its use. Meanwhile, a pilot program has introduced AI-supported prior authorization in traditional Medicare, where such requests are otherwise rare.

The report also highlights variation among insurers, with differences in request frequency, denial rates, and appeal outcomes.

Olsen, E. (2026, February 3). Medicare Advantage prior authorization requests rise in 2024: Report. Healthcare Dive.