Medicare Advantage plans denied a record 3.4 million requests for prior authorization in 2022, according to federal data. This accounts for 7.4% of the 46.2 million requests submitted on behalf of enrollees that year. The share of prior authorization requests denied by Medicare Advantage plans has been increasing over the years.
In 2019, it was 5.7%, in 2020 it was 5.6%, and in 2021 it was 5.8%. Experts suggest that one reason for the increase in denials could be the rise in Medicare Advantage enrollment. Between 2019 and 2022, the number of enrollees in these plans grew from 22 million to 28 million people.
Denials increase amid rising enrollments
Some lawmakers and other stakeholders are concerned that prior authorization requirements and processes may hinder access to necessary care. Jeannie Fuglesten Biniek, Nolan Sroczynski, and Tricia Neuman from KFF noted that just 9.9% of prior authorization requests that were denied were appealed in 2022.
They think the low rate of appeals could be due to members not knowing they can appeal a decision or finding the process intimidating. To address these issues, the Centers for Medicare & Medicaid Services announced a final rule in April. The rule aims to support Medicare Advantage beneficiaries who have been denied coverage.
Sector leaders expect the rule to significantly help both beneficiaries and long-term care providers.
- Newsweek.”Medicare Advantage Is Denying More Requests for Seniors’ Care: Report”.
- KFF.”Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization”.
- McKnightsSeniorLiving.”Medicare Advantage plan denials for prior authorization set record at 3.4 million”.