The number of prior authorization determinations issued by Medicare Advantage insurers continued to grow in 2023, according to a new report from KFF.
The report, published Jan. 29, examines data from 2023, the latest year available. That year, Medicare Advantage insurers made 49.8 million prior authorization determinations, or 1.8 per MA enrollee.
The growing number of MA beneficiaries means growing prior authorization requests, according to KFF. The number of prior authorization determinations have increased each year since 2021. The number of requests per beneficiary was largely unchanged from 2022 to 2023. In 2022, insurers approved 1.7 prior authorization requests per beneficiary.
Here are 10 other things to know:
- MA insurers denied 3.2 million, or 6.4%, of prior authorization requests in 2023.
- The percentage of denied prior authorization requests declined from 2022, when MA insurers denied 7.4% of requests that year.
- The majority of denied prior authorization requests were not appealed. In 2023, 11.7% of denied requests were appealed.
- The share of denied requests that were appealed increased since 2019, when 7.5% of denied requests were appealed.
- In 2023, more than 4 in 5 prior authorizations that were denied were eventually approved after an appeal.
- The number of prior authorizations varied by insurer. Humana and Anthem had the highest rate of prior authorization determinations per beneficiary, at 3-to-1.
- Kaiser Permanente had the lowest, at 0.5 prior authorization determinations per beneficiary.
- The number of prior authorization denials also varied by insurer. Centene had the highest rate of denials, at 13.6%. Humana had the lowest rate, at 3.5%.
- Prior authorization is used for a small share of traditional Medicare services, and has increased over the past three years. In 2023, CMS completed 393,749 prior authorization reviews, up from around 261,000 in 2022.
- In 2023, CMS denied 28.8% of prior authorization requests in traditional Medicare.
Read the full report here.