Health Plans Deny Between 12% & 18% Of Prior Authorization Requests

Health insurers denied between 12% and 18% of standard prior authorization requests in 2025 in Medicare Advantage, Medicaid managed care, and Affordable Care Act (ACA) Marketplace plans. Medicare Advantage insurers denied an average of 12% of standard prior authorization requests, Medicaid managed care insurers denied 14%, and ACA Marketplace insurers denied 18%. Denial rates for expedited requests were slightly lower, at 10%, 12%, and 16%, respectively.

Denial rates varied substantially within each market. Standard request denial rates ranged from 5% to 17% among the Medicare Advantage insurers analyzed, from 2% to 23% among Medicaid managed care insurers, and from 3 . . .