Blab Politics
OIG Finds Medicare Advantage Plans Deny Post-Acute Care at High Rates, Especially UnitedHealth, Humana, CVS
When a senior’s hospital stay ends, the next step—post‑acute care—can become a bureaucratic hurdle. On June 11, 2026, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) released two reports that paint a stark picture of how Medicare Advantage (MA) insurers are denying requests for long‑term care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities (SNFs) at rates far above the industry norm.
The OIG’s analysis drew on data from 19 MA plans that together covered 29.3 million beneficiaries in 2024—about 86 % of all MA enrollment. Across the board, the plans denied nearly two‑thirds of long‑term care hospital admissions and more than half of inpatient rehabilitation requests. SNF denials were lower overall at 12 %, but the range was wide, from 0.4 % to 23 %.
UnitedHealth, Humana and CVS, the three largest MA operators by enrollment, dominated the picture. Each denied over 70 % of long‑term care hospital requests and more than 50 % of inpatient rehab requests. In the SNF arena, the trio also posted some of the highest denial rates, with UnitedHealth’s figure among the top.
Appeals were relatively rare. Enrollees filed appeals for roughly one‑third of denied long‑term care and inpatient rehab requests, and fewer than one‑fifth of denied SNF requests. When appeals were pursued, insurers overturned 36 % of long‑term care denials, 43 % of inpatient rehab denials, and a striking 95 % of SNF denials. UnitedHealth’s SNF appeals were overturned 99.7 % of the time.
The OIG cautions that the combination of high denial and overturn rates raises the possibility that some beneficiaries were initially denied medically necessary care. Delays in securing post‑acute services can lengthen hospital stays, increase infection risk, and worsen recovery outcomes.
These findings add to a growing body of evidence that MA plans use prior authorization to restrict care. The OIG points to algorithmic tools and third‑party contractors—such as UnitedHealth’s NaviHealth, which processed over one‑third of long‑term care and inpatient rehab requests—as potential contributors to the elevated denial rates.
Insurers defend prior authorization as a mechanism to curb unnecessary services. The American Health Insurance Plans (AHIP) association said the OIG report omitted context such as paperwork errors and the high cost of post‑acute care. The Better Medicare Alliance’s president noted that plans have voluntarily eliminated millions of prior authorizations since 2024.
CMS has been reviewing prior authorization practices for years. In 2024 it launched a data‑collection pilot, began auditing coverage policies with high denial rates, and moved to standardize procedures while encouraging plans to reduce the scope of services subject to review.
The OIG recommends that CMS collect more detailed data on prior authorizations—including from contractors—to identify potential bad actors. The agency stresses that as MA enrollment grows—from 51 % of Medicare beneficiaries today to an expected 56 % in a decade—ensuring plans deliver the care they are paid to provide becomes increasingly urgent.
The reports arrive amid congressional scrutiny of MA plans. Earlier this year, members of Congress questioned CEOs of UnitedHealth and CVS about prior authorization practices, and the Senate’s 2024 report on MA prior authorization highlighted higher denial rates for post‑acute care.
At present, the OIG has not taken enforcement action, but the reports signal that regulators may intensify oversight of MA plans’ denial practices. MA beneficiaries and advocacy groups will likely monitor how CMS and the OIG respond.
The current situation is that MA plans continue to deny a significant share of post‑acute care requests, especially those covered by UnitedHealth, Humana and CVS. Appeals overturn a majority of these denials, but the delay and burden on patients remain a concern. The next steps will involve CMS reviewing the OIG’s recommendations and potentially tightening prior authorization rules to protect seniors’ access to care.
The OIG’s analysis drew on data from 19 MA plans that together covered 29.3 million beneficiaries in 2024—about 86 % of all MA enrollment. Across the board, the plans denied nearly two‑thirds of long‑term care hospital admissions and more than half of inpatient rehabilitation requests. SNF denials were lower overall at 12 %, but the range was wide, from 0.4 % to 23 %.
UnitedHealth, Humana and CVS, the three largest MA operators by enrollment, dominated the picture. Each denied over 70 % of long‑term care hospital requests and more than 50 % of inpatient rehab requests. In the SNF arena, the trio also posted some of the highest denial rates, with UnitedHealth’s figure among the top.
Appeals were relatively rare. Enrollees filed appeals for roughly one‑third of denied long‑term care and inpatient rehab requests, and fewer than one‑fifth of denied SNF requests. When appeals were pursued, insurers overturned 36 % of long‑term care denials, 43 % of inpatient rehab denials, and a striking 95 % of SNF denials. UnitedHealth’s SNF appeals were overturned 99.7 % of the time.
The OIG cautions that the combination of high denial and overturn rates raises the possibility that some beneficiaries were initially denied medically necessary care. Delays in securing post‑acute services can lengthen hospital stays, increase infection risk, and worsen recovery outcomes.
These findings add to a growing body of evidence that MA plans use prior authorization to restrict care. The OIG points to algorithmic tools and third‑party contractors—such as UnitedHealth’s NaviHealth, which processed over one‑third of long‑term care and inpatient rehab requests—as potential contributors to the elevated denial rates.
Insurers defend prior authorization as a mechanism to curb unnecessary services. The American Health Insurance Plans (AHIP) association said the OIG report omitted context such as paperwork errors and the high cost of post‑acute care. The Better Medicare Alliance’s president noted that plans have voluntarily eliminated millions of prior authorizations since 2024.
CMS has been reviewing prior authorization practices for years. In 2024 it launched a data‑collection pilot, began auditing coverage policies with high denial rates, and moved to standardize procedures while encouraging plans to reduce the scope of services subject to review.
The OIG recommends that CMS collect more detailed data on prior authorizations—including from contractors—to identify potential bad actors. The agency stresses that as MA enrollment grows—from 51 % of Medicare beneficiaries today to an expected 56 % in a decade—ensuring plans deliver the care they are paid to provide becomes increasingly urgent.
The reports arrive amid congressional scrutiny of MA plans. Earlier this year, members of Congress questioned CEOs of UnitedHealth and CVS about prior authorization practices, and the Senate’s 2024 report on MA prior authorization highlighted higher denial rates for post‑acute care.
At present, the OIG has not taken enforcement action, but the reports signal that regulators may intensify oversight of MA plans’ denial practices. MA beneficiaries and advocacy groups will likely monitor how CMS and the OIG respond.
The current situation is that MA plans continue to deny a significant share of post‑acute care requests, especially those covered by UnitedHealth, Humana and CVS. Appeals overturn a majority of these denials, but the delay and burden on patients remain a concern. The next steps will involve CMS reviewing the OIG’s recommendations and potentially tightening prior authorization rules to protect seniors’ access to care.
