The 3 Biggest Medicare Advantage Insurers Deny Over 70% of Long-Term Care Requests, Watchdog Finds

Sometimes, the best way to keep more of your money is to be aware of just how your health insurance works. A June 2026 HHS Office of the Inspector General finding revealed that three of the largest Medicare Advantage insurers by enrollment have denied a disproportionate percentage of requests for long-term acute care hospital admission, leaving enrollees without the specialized care they need.

The revelation sheds light on the challenges that navigating health insurance may pose, and it also highlights how important it may be for you to advocate for yourself and your care needs.

Insurers are denying long-term acute care

According to two reports published by the HHS Office of the Inspector General, UnitedHealth, Humana, and CVS have refused Medicare Advantage post-acute care preapproval requests at a significantly higher rate than other insurance companies. Post-acute care after a hospital stay might include a referral to a long-term care hospital or inpatient rehabilitation facility to help enrollees recover after an illness, injury, or surgery. It may also include skilled nursing care requests.

The reports revealed that the three insurance companies in question denied more than 70% of requests for long-term care hospital admission, and more than half of requests for inpatient rehabilitation facility admission.

Skilled nursing denials were lower, but they were still concentrated among these three insurers. UnitedHealth, Humana, and CVS collectively denied 12% of skilled nursing facility admission requests, and the insurers denied them at some of the highest rates of any Medicare Advantage insurers.

What this means for Medicare enrollees

With Medicare Advantage enrollment growing, these widespread denials are an issue impacting an increasing portion of the population. Approximately 51% of Medicare beneficiaries are enrolled in Medicare Advantage, and government projections indicate enrollment may grow to over 56% of Medicare beneficiaries over the coming decade.

That means that tens of millions of Americans may not be receiving the care they need, because their preapprovals are denied.

The appeals process

Only about one-third of denied long-term care and inpatient rehab admission requests were appealed. Less than one-fifth of skilled nursing care denials were appealed.

When Medicare Advantage enrollees filed appeals, the insurers overturned 36% long-term care hospital, 43% of inpatient rehab facility, and 95% of skilled nursing facility denials. Those overwhelmingly high overturn rates upon appeals suggest that many enrollees were initially denied care that was medically necessary, and that care should have been initially approved.

The impacts for Medicare Advantage enrollees

The data is revealing and carries strong implications for Medicare Advantage enrollees. Few beneficiaries appeal these denials, but the appeals frequently succeed.

Additionally, delays in post-acute care may carry significant health consequences. Individuals who need post-acute care are often in a hospital when the preapproval request is filed. If that care is denied or delayed, patients may be billed for additional days of hospital care. Longer hospital stays may increase a patient's risk of acquiring an infection, and delayed transfer for a rehab facility may increase a patient's care needs.

It's important to understand these implications and the frequency of care denials among certain Medicare Advantage insurers when choosing a Medicare Advantage plan. When evaluating Medicare Advantage plans, denial rates for post-acute care are worth factoring in alongside premiums and network coverage, particularly for anyone who anticipates needing rehabilitation or skilled nursing care after a hospital stay. 

The insurers' push for balance

Insurer lobbyists have pushed back against the reports' findings, noting that the reports omitted context that may contribute to denials, such as if doctors submit incorrect information, leading to paperwork issues.

Criticism of prior authorization (getting the plan's approval before care is delivered) is common, but the insurance industry advocates for their importance, especially when it comes to post-acute care. While insurers have worked to reduce prior authorizations since 2024, insurance industry trade groups highlight their importance because of concerns over variations about post-acute care cost and quality.

The Centers for Medicare & Medicaid Services has also gotten involved in the issue, and is working to standardize the prior authorization process and bring that process online.

Navigating Medicare Advantage prior authorization

It's a good idea to make sure you fully understand your Medicare Advantage plan's prior-authorization rules for post-acute care. Ideally, take the time to review your policy's rules in advance so you're familiar with the process and your coverage before you ever need post-acute care. If you find yourself in need of care, be sure to keep any denial paperwork and appeal rather than accept a first denial, since the odds of reversing a denial for post-acute care are meaningfully in your favor.

Bottom line

The report's findings aren't an enacted policy change, but they do highlight a significant issue that needs additional attention. As more Americans enroll in Medicare Advantage, it's possible that more pre-authorization requests could be denied, meaning more Americans go without the care they need.

Staying on top of your health insurance coverage and advocating for yourself might help you lower your financial stress and support your health, too.

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