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  • Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024

    Issue Brief

    Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024, of which 4.1 million (7.7%) were denied. Just 11.5% of denied requests were appealed, though 80.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.

  • Trump Has No Health Plan, He Has the Art of the Health Care Deal

    From Drew Altman

    In his first column for the new year, KFF CEO Dr. Drew Altman analyzes President Trump’s “make a deal” approach to health care. He explains that while the president doesn’t have a health reform plan, or even “concepts of a plan,” or a replacement for the ACA, he does have a distinctive set of tactics that features one-off deals with the health care industry that are more like “health policy by transaction.” He writes that the deals “even do some good,” but “don’t change the long-term incentives of the health care companies that participate in the deals,” and a big question is “whether they have staying power.”

  • Health Policy in 2026

    From Drew Altman

    In a new column, President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026. “First and foremost,” he writes, “is the role health care affordability will play in the midterms.” And, he notes: “The average cost of a family policy for employers could approach $30,000 and cost sharing and deductibles will rise again after plateauing for several years.”

  • States’ Management of Medicaid Home Care Spending Ahead of H.R. 1 Effects

    Issue Brief

    Using data from the 23rd KFF survey of officials administering Medicaid home care programs, this issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.

  • Why We Are Stuck with Prior Authorization Review

    From Drew Altman

    Prior authorization review frustrates patients and physicians, but we likely can’t just eliminate it. In his new column, President and CEO Dr. Drew Altman discusses why, and why the focus is now instead on “doing it smarter.” Altman writes: “A proposal to eliminate prior authorization altogether could be the single most tangible and popular health reform idea a candidate could make. But, in our fragmented health system, with no great way to control costs or limit unnecessary care, we seem to be stuck with prior authorization review…and most payers are now trying to ‘do prior authorization review smarter.’”