Seniors’ Act and Prior Authorization in Medicare Advantage (MA)
The Regulatory Relief Coalition (RRC )shared a new KFF analysis that speaks directly to the case for the Seniors’ Act and specifically calls out prior authorization in Medicare Advantage (MA).
A 2024 CMS rule now requires insurers in MA, Medicaid managed care, and ACA Marketplace plans to publicly report their prior authorization data every year, including approval rates, denial rates, and response times. The first round, covering 2025, was due at the end of March 2026. KFF gathered and analyzed those figures from the largest insurers in each market, 14 companies covering about 71 million people producing one of the first side-by-side pictures of how often coverage gets denied and what happens when patients challenge it.
The denial rates for standard requests were:
- MA:12% (ranging from 5% at Elevance to 17% at UnitedHealth)
- Medicaid managed care:14%
- ACA Marketplace:18%
Denials are rarely appealed, but when they are, a striking share get reversed:
- MA: 67% overturned on appeal
- Medicaid managed care: 47% overturned on appeal
- ACA Marketplace:43% overturned on appeal
That pattern raises real questions about how many of those requests should have been approved from the start. Response times, by contrast, looked quick, about a day for standard requests across all three markets. KFF notes that a median can mask how often decisions run past the deadline.
KFF is transparent about the data’s limitations. Insurers report only percentages rather than actual numbers, use inconsistent formats, and don't break results out by service type, making it tough for patients to compare plans or see what’s really behind a high denial rate. CMS has proposed tightening these requirements for 2027. Notably, the analysis points to the Improving Seniors’ Timely Access to Care Act, which would require MA plans to report prior authorization data to HHS each year for public posting, including how often decisions are made using tools like artificial intelligence.
You can read the full KFF report here.