Prior authorization and Medicare Advantage: 6 things to know

Becker's Healthcare September 24, 2024
Claire Wallace

Nearly 99%Medicare Advantage patients are required to obtain prior authorization for certain services.

The Kaiser Family Foundation published an Aug. 8 report breaking down key statistics on Medicare Advantage patients and prior authorization based on data submitted by Medicare Advantage insurers to CMS for 2019 through 2022.

Here are six things to know about prior authorization and Medicare Advantage:

1. More than 46 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of program enrollees in 2022, up from 37 million in 2019.

2. In 2022, there were 1.7 prior authorization requests per Medicare Advantage enrollee, similar to 2019.

3. In 2022, insurers fully or partially denied 3.4...

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