Medicare Advantage Prior Authorization Scorecard
Compare prior authorization denial rates across 37 Medicare Advantage plans. Find which plans deny the most care requests. Plan and enrollment data is drawn from CMS across all 50 states; see our methodology.
What is prior authorization? Medicare Advantage plans often require pre-approval before covering certain treatments, drugs, or procedures.
Plans with high denial rates may delay or block necessary care. The appeal overturn rate shows how often denials are reversed on appeal — a high rate suggests many denials were inappropriate.
Data reflects prior authorization requests and denials from CMS OIG and KFF Medicare Advantage analysis. This is for informational purposes only and does not constitute medical advice. Contact CMS or your plan for coverage decisions.
| # | Plan / Organization | Type | PA Requests | PA Denial Rate | Appeals Filed | Overturn Rate |
|---|---|---|---|---|---|---|
| 1 | Kaiser Permanente MA Contract: H1189 | HMO | 620,000 | 4.2% | 3,906 | 81.0% |
| 2 | Group Health Cooperative MA Contract: H0543 | HMO | 112,000 | 4.8% | 806 | 82.0% |
| 3 | Landmark Health UHC Contract: H3927 | HMO | 32,000 | 4.9% | 235 | 83.0% |
| 4 | Security Health Plan MA Contract: H1167 | HMO | 34,000 | 5.1% | 260 | 79.0% |
| 5 | UCare Health MA Contract: H3387 | HMO | 54,000 | 5.2% | 421 | 80.0% |
| 6 | Clover Health Contract: H1902 | HMO | 85,000 | 5.4% | 689 | 78.0% |
| 7 | AultCare MA Contract: H8057 | HMO | 29,000 | 5.5% | 239 | 75.0% |
| 8 | SummaCare MA Contract: H4807 | HMO | 27,000 | 5.6% | 227 | 76.0% |
| 9 | Geisinger Health Plan MA Contract: H1298 | HMO | 63,000 | 5.8% | 548 | 77.0% |
| 10 | Health Alliance Plan MA Contract: H1724 | HMO | 67,000 | 5.9% | 593 | 74.0% |
| 11 | SCAN Health Plan Contract: H5599 | HMO | 185,000 | 6.1% | 1,693 | 76.0% |
| 12 | ArchCare MA Contract: H8312 | HMO | 41,000 | 6.2% | 381 | 74.0% |
| 13 | UnitedHealthcare Contract: H0028 | HMO | 2,100,000 | 6.3% | 19,845 | 72.0% |
| 14 | Independent Health MA Contract: H5253 | HMO | 48,000 | 6.3% | 454 | 71.0% |
| 15 | Medica Health Plan MA Contract: H2092 | HMO | 58,000 | 6.4% | 557 | 70.0% |
| 16 | UPMC Health Plan MA Contract: H2762 | HMO | 142,000 | 6.7% | 1,427 | 73.0% |
| 17 | Capital BlueCross MA Contract: H5216 | HMO | 95,000 | 6.8% | 969 | 69.0% |
| 18 | Devoted Health Contract: H3895 | HMO | 67,000 | 6.9% | 693 | 72.0% |
| 19 | Tufts Health Plan MA Contract: H1245 | PPO | 87,000 | 7.1% | 927 | 68.0% |
| 20 | BCBS Michigan MA Contract: H4152 | PPO | 310,000 | 7.2% | 3,348 | 66.0% |
| 21 | Presbyterian Healthcare MA Contract: H1542 | HMO | 76,000 | 7.3% | 832 | 69.0% |
| 22 | EmblemHealth Contract: H0755 | HMO | 130,000 | 7.4% | 1,443 | 69.0% |
| 23 | Highmark MA Contract: H1036 | PPO | 180,000 | 7.9% | 2,133 | 65.0% |
| 24 | Cigna MA Contract: H5416 | HMO | 290,000 | 8.1% | 3,524 | 70.0% |
| 25 | Blue Shield California MA Contract: H3959 | HMO | 240,000 | 8.6% | 3,096 | 71.0% |
| 26 | CareMore Health Elevance Contract: H2237 | HMO | 125,000 | 8.8% | 1,650 | 64.0% |
| 27 | Alignment Healthcare MA Contract: H8432 | HMO | 78,000 | 8.9% | 1,041 | 67.0% |
| 28 | Anthem Elevance MA Contract: H2819 | HMO | 750,000 | 9.3% | 10,463 | 63.0% |
| 29 | Florida Blue MA Contract: H5350 | HMO | 420,000 | 9.6% | 6,048 | 66.0% |
| 30 | Oscar Health MA Contract: H2222 | HMO | 43,000 | 9.7% | 626 | 62.0% |
| 31 | Humana Contract: H0630 | HMO | 1,450,000 | 10.4% | 22,620 | 68.0% |
| 32 | CVS Health / Aetna MA Contract: H5521 | HMO | 980,000 | 11.2% | 16,464 | 75.0% |
| 33 | CarePlus Humana FL Contract: H4931 | HMO | 210,000 | 11.8% | 3,717 | 64.0% |
| 34 | Bright Health MA Contract: H2748 | HMO | 120,000 | 12.3% | 2,214 | 55.0% |
| 35 | Centene WellCare MA Contract: H3576 | HMO | 410,000 | 13.8% | 8,487 | 59.0% |
| 36 | Molina Healthcare MA Contract: H3132 | HMO | 380,000 | 14.7% | 8,379 | 61.0% |
| 37 | WellCare Florida MA Contract: H3499 | HMO | 290,000 | 15.2% | 6,612 | 57.0% |
Data: CMS OIG OEI-09-22-00380 and KFF 2023 Medicare Advantage analysis. Sorted by PA denial rate (lowest first = best).
Not affiliated with CMS or any government agency.