Medicare Advantage plans denied prior authorization requests at unusually high rates, HHS report finds

June 11, 2026 - 07:56

A new report from the Department of Health and Human Services' inspector general reveals that some major Medicare Advantage insurers rejected prior authorization requests at unusually high rates, particularly for long-term care services. The findings highlight ongoing concerns about access to care for millions of older Americans enrolled in private Medicare plans.

The report specifically called out UnitedHealthcare, CVS Health, and Humana for having the highest denial rates when it came to requests for long-term care coverage. These denials often involved services like skilled nursing facility stays, home health aide support, and rehabilitation therapy. The inspector general's office analyzed data from 2019 to 2021 and found that some plans denied more than one in five prior authorization requests for certain types of care.

Critics argue that these high denial rates may be driven by profit motives rather than medical necessity. Medicare Advantage plans are paid a fixed amount per enrollee, which gives them an incentive to limit expensive services. The report also noted that many denied requests were later overturned on appeal, suggesting that initial denials were not always justified.

The findings come as the Biden administration has pushed for stricter oversight of Medicare Advantage plans. New rules taking effect in 2024 require insurers to follow more consistent standards when reviewing prior authorization requests. Consumer advocates say the report underscores the need for continued vigilance, as seniors often face delays or denials when they need care the most.