WASHINGTON, D.C. – With more than half of all eligible Medicare beneficiaries enrolled in a Medicare Advantage (MA) plan, a survey from the American Health Care Association (AHCA) finds that MA plans are denying or delaying medically necessary post-acute care, often against medical professionals’ recommendations, on a daily and weekly basis.
The results of the survey, conducted by AHCA in May 2025 of 363 nursing home providers, adds to existing research that finds post-acute care is disproportionately impacted by MA prior authorizations. Additional research has also found that while a small share of denied prior authorization requests are appealed, most appeals are partially or fully overturned.
“This constant hoop jumping is resulting in too many skilled nursing patients being discharged too soon against medical advice, threatening their recovery,” said Clif Porter, president and CEO of AHCA. “We want to make sure Medicare Advantage plans are providing the therapy benefits our seniors were promised and are not leaving important—sometimes life-saving—medical decisions to AI or insurers without appropriate guardrails and oversight. There is a better way to approach coverage decisions: where we put patients and their care team at the center of every decision.”
Highlights from the survey include:
Denials or delays of medically necessary post-acute care by Medicare Advantage occur daily and/or weekly for two-thirds of skilled nursing providers.
- Providers report denials or delays of post-acute care services:
- Weekly (37 percent)
- Daily (29 percent)
- Monthly (17 percent)
The majority of providers have encountered situations in which a resident’s coverage is pulled prematurely against the advice of the resident’s medical care team:
- More than two-thirds (67 percent) of providers have encountered situations in which a MA plan pulled coverage for a resident against medical advice.
More than half of providers report that denials for care are frequently overturned once appealed, indicating a flawed or unfounded initial denial.
- Providers report that initial claims denials are reversed upon appeal always (3 percent) or sometimes (54 percent) compared to rarely (32 percent).
“Recent commitments from many insurance providers to do better on prior authorizations are encouraging, but these survey results remind us that there is still a long way to go, especially in post-acute care,” said Nisha Hammel, Vice President of Reimbursement Policy & Population Health at AHCA. “We want plans that are working well to continue to serve seniors, and we want seniors to have choices that work for their needs. We encourage federal policymakers to advance opportunities to enhance Medicare Advantage, so we can all realize its potential.”
AHCA’s May survey of providers was released in part earlier this year during the budget reconciliation debate. The survey asked providers about several key policy issues related to The Better Way, AHCA’s forward-looking policy agenda to deliver bold solutions for quality long term and post-acute care. One of the policy priorities is “Reaffirming the Promise of Medicare Advantage,” offering several recommendations for alignment among providers, residents, policymakers, and the public. Learn more about The Better Way HERE.
Access the Provider Insights: Medicare Advantage report HERE.