Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023

(By Jeannie Fuglesten Biniek, Nolan Sroczynski, Meredith Freed, and Tricia Neuman for The Kaiser Family Foundation Published: Jan 28, 2025)

Virtually all enrollees in Medicare Advantage (99%) are required to obtain prior authorization for some services – most commonly, higher cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. This contrasts with traditional Medicare, where only a limited set of services, including certain outpatient hospital services, non-emergency ambulance transport, and durable medical equipment, require prior authorization (see Box 1). Continue reading here…

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