Medicare Advantage

Medicare Advantage plans denied 3.4 million prior authorization requests for health care services in whole or in part in 2022, or 7.4% of the 46.2 million requests submitted on behalf of enrollees that year, according to a new KFF analysis of federal data. That was a higher share of denials…

Medicare Advantage plans denied 3.4 million prior authorization requests for health care services in whole or in part in 2022, or 7.4% of the 46.2 million requests submitted on behalf of enrollees that year. The volume of prior authorization requests, the share denied, the share of denials that were appealed, and the share that were overturned upon appeal varied across Medicare Advantage insurers.

In 2024, more than half (54%) of eligible Medicare beneficiaries are enrolled in Medicare Advantage plans. This brief provides current information about Medicare Advantage enrollment, by plan type and firm, and shows how enrollment varies by state and county.

This brief provides information about Medicare Advantage plans in 2024, including premiums, out-of-pocket limits, supplemental benefits, and prior authorization, as well as trends over time.

Changes to the Medicare Part D benefit in the Inflation Reduction Act will mean lower out-of-pocket costs for Part D enrollees but higher costs for Part D plans overall, leading to concerns about possible premium increases. These FAQs provide context for understanding Part D premiums in 2025 and changes in recent years, and describe actions the Centers for Medicare & Medicaid Services (CMS) is taking to mitigate potential premium increases.

This issue brief merged beneficiary-level Medicare and Medicaid data from 2021 to document sources of coverage for dual-eligible individuals nationwide and by state.

This analysis examines the recent growth of Medicare Advantage as a share of hospital inpatient days. Medicare Advantage rose from 13% to 23% of all inpatient days from 2015 to 2022, although there was wide variation among hospitals.

This brief analyzes 2024 Medicare Part D enrollment, premiums, and cost sharing. The analysis highlights the continued growth in Medicare Advantage enrollment in the Part D marketplace and substantially higher average monthly premiums for stand-alone Part D drug plan coverage. Changes to the Part D benefit included in the Inflation Reduction Act are helping to lower out-of-pocket costs for patients but could also contribute to higher-priced Part D coverage.

This analysis examines the extent to which states are providing health benefits to their Medicare-eligible retirees through Medicare Advantage arrangements. In 2024, a majority of states offer Medicare Advantage plans to their state retirees, with 13 offering Medicare Advantage exclusively.

Using health insurer financial data for 2023, we find that in 2023, per enrollee gross margins were highest in the Medicare Advantage market, and medical loss ratios were lowest in the individual insurance market. Across most markets, gross margins have been relatively stable in recent years.