Medicare appeal rules are supposed to protect seniors from unfair denials, but the system is increasingly working against the very people it was designed to help. Medicare Advantage plans are denying more care than ever, and older adults are being forced to pay out of pocket or go without treatment while they wait for decisions.
In 2024 alone, Medicare Advantage insurers processed nearly 53 million prior‑authorization requests, denying 7.7% of them—an increase from the previous year. Even worse, only 11.5% of denied requests were appealed, despite the fact that most appeals are ultimately overturned. As a result, seniors are facing higher bills, more delays, and a confusing appeals process that feels stacked against them.
