Private Medicare Advantage insurers denied care requests for older adults at alarmingly high rates, according to federal watchdog reports released June 11, 2026, with some companies rejecting over 80% of applications for long-term care, USA Today and NBC News reported.
Denial Rates Vary Widely Across Insurers
The Department of Health and Human Services’ Office of Inspector General found that 80% of long-term care requests were denied by CVS Health’s Aetna plan, the highest rate among 19 Medicare Advantage plans studied. Humana and UnitedHealth Group rejected over 70% of such requests, while smaller insurers averaged 42% denials. For rehabilitation facilities, UnitedHealth rejected 66% of applications, with Humana and CVS Health denying more than half, USA Today reported.
These rates contrast sharply with the 8% to 80% range cited by the inspector general in a separate report, highlighting “shocking variation” across insurers, NBC News noted. The disparity raises concerns about “financial incentives” driving rejections, as for-profit plans were more likely to deny care than nonprofit counterparts.
Financial Incentives and Patient Burden
Medicare Advantage plans, which serve 20 million Americans, operate under a fixed federal funding model that rewards cost-cutting. Insurers use “prior authorization” — a process requiring preapproval for specialized care — to limit expenses, often forcing patients to pay out-of-pocket or forgo necessary treatment. “Imagine knowing you’re not ready to go home, you can’t go to the bathroom, you still need help but they’re saying no,” said Nicole Fallon of LeadingAge, a nursing home advocacy group, USA Today quoted.
The financial toll is steep: long-term acute care hospitals cost $49,000 on average, compared to $24,000 for rehabilitation facilities and $16,000 for skilled nursing, USA Today reported. Patients denied care often face “stress and uncertainty,” with one advocate noting, “You’re stressed and you ask, ‘What am I going to do? I can’t take care of myself at home,’” USA Today quoted.
High Overturn Rates and Regulatory Pushback
Despite the high denial rates, 95% of appeals for skilled nursing facility care were overturned, suggesting “a breakdown” in the initial approval process, NBC News reported. Rosemary Bartholomew, lead author of the HHS reports, called the findings “extremely high,” while Erin Bliss of HHS expressed surprise at the “shocking variation” in denial rates.
Health Secretary Robert F. Kennedy Jr. has pledged reforms, including streamlining prior authorization rules. In April, industry group AHIP said major insurers eliminated 11% of preapproval requirements, and UnitedHealthcare removed two-thirds of authorizations for children, NBC News noted. However, experts caution that systemic changes will take time, with Miranda Yaver of the University of Pittsburgh stating, “It’s another data point that reinforces what a lot of Americans have already been articulating a lot of frustration about — which is that healthcare decisions are being made with profit rather than medical necessity in mind,” NBC News quoted.
Pressure for Transparency and Accountability
The reports have intensified scrutiny of Medicare Advantage plans, which cover 35 million Americans. Critics argue that the system prioritizes insurer profits over patient needs, with one advocate stating, “The reports ignore serious, well-documented concerns about wide variations in the cost and quality of post-acute care and skilled nursing facilities,” USA Today quoted. The inspector general’s findings could prompt legislative action, though the timeline remains unclear.
For now, seniors facing denied care requests face a daunting process. “Any time we see such a wide range of denial rates, it raises concerns for us that some patients may not be getting access to the care that they need,” said a federal official, NBC News reported. As the debate over healthcare access intensifies, the human cost of these policies grows increasingly difficult to ignore.
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