Health Plans Overturned 43% To 67% Of Appealed Prior Authorization Denials In 2025

Health insurers denied between 12% and 18% of standard prior authorization requests in 2025, according to an analysis of newly required federal reporting from the largest insurers in Medicare Advantage, Medicaid managed care, and the Affordable Care Act (ACA) Marketplace.

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 among insurers within each market. Standard request denial rates ranged from 5% to 17% among the Medicare . . .