Prior Authorization Data Tracker
Medicare Advantage — aggregate (all contracts) · as of 2026-03-31 · next release 2027-03-31
Aggregate Medicare Advantage prior-authorization figures from public analyses of CMS data. Payer-level CMS-0057-F reports (first due 31 March 2026) are normalized in as they are released — see the update log at the foot of the page.
Determinations over time
Aggregate Medicare Advantage. Read these with the caveats on how to read the data honestly — a raw denial rate conflates categories, and an overturn rate is not a wrongness rate.
The numbers
| Year | Determinations | Denied | Appealed | Overturned | Source |
|---|---|---|---|---|---|
| 2024 | 53M | 7.7% | 11.5% | >80% | KFF analysis of CMS data |
| 2022 | 46.2M | — | — | — | KFF analysis of CMS data |
By payer
Normalized from payer CMS-0057-F filings, as of 2026-07-30, sorted by denial rate. Each figure is the payer's own published number — read it against the caveats above.
| Payer | Scope | Year | Denied | Approved | Appeal-overturn | Source |
|---|---|---|---|---|---|---|
| Cigna Healthcare | Individual & Family Plans (FFE/QHP) — aggregate | 2025 | 27% | 73% | 16% | link |
| Aetna | Medicare Advantage — Contract H9431 | 2025 | 19.86% | 80.14% | 93.75% | link |
| Aetna | Medicare Advantage — Contract H5309 | 2025 | 16.34% | 83.66% | 95.37% | link |
| Aetna | Medicare Advantage — Contract H8332 | 2025 | 13.18% | 86.82% | 72.22% | link |
| Aetna | Medicare Advantage — Contract H4523 | 2025 | 12.73% | 87.27% | 88.96% | link |
| Aetna | Medicare Advantage — Contract H8597 | 2025 | 12.65% | 87.35% | 86.35% | link |
| Aetna | Medicare Advantage — Contract H3219 (Allina Health) | 2025 | 11.47% | 88.53% | 80.43% | link |
| Aetna | Medicare Advantage — Contract H4711 | 2025 | 11.3% | 88.7% | 86.71% | link |
| Aetna | Medicare Advantage — Contract H3288 | 2025 | 10.94% | 89.06% | 90.48% | link |
| Aetna | Medicare Advantage — Contract H4835 | 2025 | 10.69% | 89.31% | 88.46% | link |
| Aetna | Medicare Advantage — Contract H3928 | 2025 | 10.42% | 89.58% | 87.1% | link |
| Aetna | Medicare Advantage — Contract H3239 | 2025 | 10.41% | 89.59% | 84.71% | link |
| Aetna | Medicare Advantage — Contract H1609 | 2025 | 10.36% | 89.64% | 83.79% | link |
| Aetna | Medicare Advantage — Contract H8649 | 2025 | 10.17% | 89.83% | 90.34% | link |
| Aetna | Medicare Advantage — Contract H1692 | 2025 | 9.59% | 90.41% | 90.69% | link |
| Aetna | Medicare Advantage — Contract H3931 | 2025 | 9.5% | 90.5% | 87.93% | link |
| Aetna | Medicare Advantage — Contract H3192 | 2025 | 9.37% | 90.63% | 85.3% | link |
| Aetna | Medicare Advantage — Contract H5325 | 2025 | 8.68% | 91.32% | 83.73% | link |
| Aetna | Medicare Advantage — Contract H2293 | 2025 | 8.29% | 91.71% | 88.86% | link |
| Aetna | Medicare Advantage — Contract H1608 | 2025 | 8.17% | 91.83% | 92.4% | link |
| Aetna | Medicare Advantage — Contract H5521 | 2025 | 7.86% | 92.14% | 89.7% | link |
| Aetna | Medicare Advantage — Contract H7149 | 2025 | 7.76% | 92.24% | 88.55% | link |
| Aetna | Medicare Advantage — Contract H0628 | 2025 | 7.68% | 92.32% | 89.47% | link |
| Aetna | Medicare Advantage — Contract H1109 | 2025 | 7.68% | 92.32% | 82.61% | link |
| Aetna | Medicare Advantage — Contract H5302 | 2025 | 7.44% | 92.56% | 85.65% | link |
| Aetna | Medicare Advantage — Contract H3312 | 2025 | 7.31% | 92.69% | 82.33% | link |
| Aetna | Medicare Advantage — Contract H3748 | 2025 | 7.28% | 92.72% | 90.62% | link |
| Aetna | Medicare Advantage — Contract H2056 | 2025 | 7.22% | 92.78% | 88.46% | link |
| Aetna | Medicare Advantage — Contract H3146 | 2025 | 7.09% | 92.91% | 86.28% | link |
| Aetna | Medicare Advantage — Contract H5593 | 2025 | 7% | 93% | 85.71% | link |
| Aetna | Medicare Advantage — Contract H5522 | 2025 | 6.97% | 93.03% | 90.32% | link |
| Aetna | Medicare Advantage — Contract H2663 | 2025 | 6.77% | 93.23% | 90.12% | link |
| Aetna | Medicare Advantage — Contract H5337 | 2025 | 6.59% | 93.41% | — | link |
| Aetna | Medicare Advantage — Contract H3959 | 2025 | 6.05% | 93.95% | 87.59% | link |
| Aetna | Medicare Advantage — Contract H7301 | 2025 | 6.02% | 93.98% | 89.77% | link |
| Aetna | Medicare Advantage — Contract H1206 | 2025 | 5.96% | 94.04% | 87.18% | link |
| Aetna | Medicare Advantage — Contract H5793 | 2025 | 5.78% | 94.22% | 86.22% | link |
| Aetna | Medicare Advantage — Contract H3152 | 2025 | 5.5% | 94.5% | 81.2% | link |
| Aetna | Medicare Advantage — Contract H3597 | 2025 | 5.46% | 94.54% | 91.25% | link |
| Aetna | Medicare Advantage — Contract R6694 | 2025 | 5.46% | 94.54% | 94.74% | link |
| Blue Cross Blue Shield of Massachusetts | Medicare Advantage HMO | 2025 | 4.61% | 95.4% | 56.57% | link |
| Blue Cross Blue Shield of Massachusetts | Medicare Advantage PPO | 2025 | 4.42% | 95.6% | 49.67% | link |
| Alliance Health | aggregate | 2025 | 2.78% | 97.22% | 42.86% | link |
| Aetna | Medicare Advantage — Contract H0523 | 2025 | 2.39% | 97.61% | 53.33% | link |
| Aetna | Medicare Advantage — Contract H4982 | 2025 | 2.04% | 97.96% | 56.58% | link |
| Aetna | Medicare Advantage — Contract H0562 | 2025 | 0% | 100% | — | link |
| UnitedHealthcare | Medicare Advantage | 2025 | — | 95.4% | — | link |
| UnitedHealthcare | Medicaid | 2025 | — | 91.5% | — | link |
| UnitedHealthcare | Employer and Individual | 2025 | — | 88.5% | — | link |
| UnitedHealthcare | Individual and Family ACA (Federal Marketplace) | 2025 | — | 80.3% | — | link |
How this stays current
This tracker is regenerated from versioned data files. Aggregate figures live in data/pa-tracker.json. Per-payer rows are produced by a two-step pipeline: fetch-reports.mjs pulls each payer's public CMS-0057-F report into data/prior-auth-reports/, then ingest-reports.mjs digests those files with Claude into data/pa-payers.json. Re-run and rebuild — the page always reflects the latest figures, and every number traces back to its source.
- 2026-03-31 Tracker seeded with Medicare Advantage aggregate (2022, 2024) from KFF analysis of CMS data.