UnitedHealthcare, CVS Health and Humana led Medicare Advantage denials for care

Seniors trying to get out of the hospital and into skilled nursing or other post-acute care can lose precious days while a plan decides whether treatment is approved. New federal findings show that some Medicare Advantage insurers denied those requests at rates that varied wildly by company, with UnitedHealthcare, CVS Health and Humana among the highest, and that most appealed skilled nursing denials were later reversed.

The Department of Health and Human Services said denial rates for long-term care prior authorization requests ranged from about 8% to 80%, a gap so wide that HHS officials called it shocking variation. A second HHS report released the same day found that when Medicare Advantage patients challenged denials for skilled nursing facility care, plans overturned 95% of them on appeal. Erin Bliss, the HHS assistant inspector general, said she was surprised by how far the rates diverged, and Rosemary Bartholomew, who led the report, said the appeal result raised concerns that something was breaking down at the initial decision stage.

The pattern echoes earlier warnings from HHS oversight work. In April 2022, the HHS Office of Inspector General reported that some Medicare Advantage organizations denied requests that met Medicare coverage rules. That review drew on a stratified random sample of 250 prior authorization denials and 250 payment denials from 15 large Medicare Advantage organizations during the week of June 1 through June 7, 2019. Investigators said those denials could delay or prevent beneficiaries from receiving medically necessary care, including advanced imaging and post-acute facility stays.

Congress has been pressing the issue as well. A Senate Permanent Subcommittee on Investigations inquiry launched on May 17, 2023, found that UnitedHealthcare, Humana and CVS denied prior authorization requests for post-acute care at much higher rates than for other services. The investigation also said UnitedHealthcare’s post-acute prior authorization denial rate climbed from 10.9% in 2020 to 22.7% in 2022 as the company increasingly automated reviews.

The broader scale is enormous. KFF reported in January 2026 that nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers in 2024, with 4.1 million denied, or 7.7%. Only 11.5% of denials were appealed. KFF also found that 99% of Medicare Advantage enrollees need prior authorization for some services, most often higher-cost care such as inpatient hospital stays, skilled nursing facility stays and chemotherapy, while traditional Medicare generally requires prior authorization for only a limited set of services.

Washington has responded with rules and promises, but the central question remains whether the denials are isolated outliers, aggressive cost control that stays within the law, or evidence that oversight is still failing the people who can least afford a delay. CMS finalized a prior authorization interoperability rule on January 17, 2024, and in June 2025 AHIP said leading plans had eliminated 11% of prior authorizations, equal to 6.5 million fewer requests. UnitedHealthcare said in May 2026 it would remove two-thirds of authorization requirements for members under 18 by year’s end, while Health Secretary Robert F. Kennedy Jr. has vowed to reform the process.