Medicare Advantage Plans Denied 13% of Skilled Nursing Admissions, Affecting 35 Million Seniors
Updated
Updated · The New York Times · Jun 11
Medicare Advantage Plans Denied 13% of Skilled Nursing Admissions, Affecting 35 Million Seniors
2 articles · Updated · The New York Times · Jun 11
Summary
Federal investigators found major Medicare Advantage insurers denied about 13% of requests for post-hospital admission to skilled nursing facilities, in cases the analysis said were inappropriate.
The HHS inspector general tied those denials to prior-authorization practices and the plans’ fixed-payment model, which rewards insurers for limiting costly inpatient rehabilitation and therapy.
UnitedHealth Group, Humana and CVS Health were the focus of two new reports, which also questioned whether contractors making care decisions for insurers were being adequately supervised.
About 35 million older Americans are enrolled in Medicare Advantage, meaning policies at a handful of dominant insurers can shape access to medically necessary care for millions.
Why does Medicare Advantage cost taxpayers billions more while denying essential care?
Will new laws finally stop insurers from profiting by denying seniors' care?
Are AI algorithms, not doctors, deciding if seniors receive life-saving care?
Medicare Advantage Prior Authorization Denials: Widespread Impact, Causes, and Regulatory Response in 2026
Overview
Medicare Advantage plans are increasingly denying or delaying medically necessary services, especially for skilled nursing patients, leading to premature discharges and putting patient recovery at risk. Healthcare providers struggle to secure needed care as crucial decisions are often made by insurers or artificial intelligence without enough oversight. Despite some efforts to improve prior authorization processes, major insurers continue to deny post-acute care at high rates, and the trend of prior authorization requests is rising. This environment creates significant challenges for both patients and providers, highlighting the urgent need for better oversight and patient-centered care.