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Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain

This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.

TrumpRx: What’s the Value for Customers?

In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.

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  • 9 Things to Watch for the 2027 ACA Open Enrollment Period 

    Issue Brief

    The ACA Marketplace Open Enrollment season begins November 1, bringing higher out-of-pocket premium payments, new eligibility requirements for certain groups, and state efforts to offset premium increases following the expiration of enhanced premium tax credits. Read our analysis of what these and other changes could mean for enrollees.

  • What We Know about Trump’s $500 ACA Checks and the User Fees Funding Them

    Issue Brief

    This analysis examines the $500 checks that the Trump administration is sending to some Affordable Care Act Marketplace enrollees and the user fees that are paying for them. The checks are going to about 1 million enrollees in the 30 states that rely on the federal HealthCare.gov Marketplace who are not receiving any tax credits this year – a small share of the 19.2 million people who were enrolled nationally as of February.

  • Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain

    Issue Brief

    This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.

  • Changes to the Medicare Advantage Program Enhance Some Consumer Protections But Roll Back Others

    Issue Brief

    CMS recently finalized policies as part of the 2027 Medicare Advantage final rule that both enhance consumer protections and roll back changes to the Medicare Advantage program that were intended to protect consumers. These changes have gotten less attention than payment issues and changes to the star ratings system, which also affect plan payments, but could have implications for Medicare beneficiaries.

  • Are Health Insurance Companies the Reason for Our Health System’s Ills? 

    Perspective

    In this JAMA Health Forum column, KFF's Larry Levitt examines the criticism that health insurance companies are facing from political leaders, and explores the industry's role in both causing and addressing some of the health systems' biggest problems, including rising costs and prior authorization review.

  • Claims Denials and Appeals in ACA Marketplace Plans in 2024

    Issue Brief

    This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.

  • TrumpRx: What’s the Value for Customers?

    Issue Brief

    In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.

  • Poll: People View Prior Authorization as Greatest Burden in Navigating the Health System

    News Release

    New KFF polling explores the challenges beyond costs that people with insurance face in navigating the health care system. People cite prior authorization review as their top problem by a wide margin, with a third (32%) saying prior authorization requirements are a “major burden.” That’s more than say the same about understanding their bill or what they owe (23% say it is a major burden), getting appointments when they need them (20%), or finding providers…