Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

Virtually all enrollees in Medicare Advantage (99%) are required to obtain prior authorization for some services – most commonly, higher cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. This contrasts with traditional Medicare, where only a limited set of services, including certain outpatient hospital services, non-emergency ambulance transport, and durable medical equipment, require prior authorization. At the same time, prior authorization processes and requirements, including the use of artificial intelligence to review requests, may result in administrative hassles for providers, delays for patients in receiving necessary care, and in some instances, denials of medically necessary services, such as post-acute care.

Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024, an increase from 2023 (49.8 million) as the number of people enrolled in Medicare Advantage has grown. Substantially fewer prior authorization requests for traditional Medicare than Medicare Advantage beneficiaries were submitted to CMS – just over 625,000 in fiscal year 2024. In 2024, there were 1.7 prior authorization requests on average per Medicare Advantage enrollee, a slight decline from 1.8 in 2023.

— KFF, January 28, 2026

Biniek, Jeannie Fuglesten, et al. “Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024.” KFF, 28 Jan. 2026. https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/.

53 million Medicare Advantage prior authorization requests in 2024: 6 notes

Here are six things to know about MA prior authorizations:

1. The number of prior authorizations decisions increased from 49.8 million in 2023, reflecting greater MA enrollment.
2. However, there was a slight decrease in prior authorization requests per enrollee. Enrollees averaged 1.7 requests in 2024 versus 1.8 in 2023.
3. MA insurers either fully or partially denied 4.1 million requests in 2024, a 7.7% share of all requests. This share was up from 6.4% in 2023 but in line with 2022’s 7.4%.
4. Only a fraction of denied requests were appealed (11.5%), while 80.7% of those were at least partially overturned.
5. Elevance and Centene saw the most prior authorization requests per enrollee in 2024 — 3.0 and 2.9 requests, respectively.
6. While UnitedHealth denied the greatest share of requests, Elevance denied the fewest: 12.8% versus 4.2%, respectively.

— Becker’s Payer Issues | Payer News, January 29, 2026

KFF: Nearly 53M prior auth requests submitted in Medicare Advantage in 2024

As MA has grown—and proven quite profitable, historically—so too has scrutiny over insurers’ behavior in this space. When a panel of health insurance executives appeared before two congressional committees earlier this month, prior auth and the role it can play in delaying patients’ access to care was a central topic.

In poll from last summer, KFF analysts found that 73% of patients believe delays and denials of care caused by health insurers is a “major problem.” In June 2025, all of the major MA insurers pledged to ease the friction associated with prior authorization, with a particular emphasis on ways technology can smooth out the process.

— Fierce Healthcare, January 29, 2026