Medicare Advantage Ads Must Now Disclose Prior Authorization Denial Rates and Reversal Times

If you’ve ever sat through a Medicare Advantage (MA) plan commercial and thought, “That sounds great, but what’s the catch?” this new bill is for you. This legislation mandates that every advertisement for an MA plan must clearly state specific, hard numbers about how often they deny care requests. Starting one year after the bill becomes law, MA plan ads will need to disclose three key data points from the previous plan year: the total number of prior authorization requests the plan denied; how many of those denials were later overturned and approved; and the average number of days it took to approve those reversed denials.

The Prior Auth Transparency Scorecard

This isn't just about adding fine print to the bottom of the screen. The bill requires both a visual display and a verbal announcement of these statistics in every ad. Think of it as a transparency scorecard baked right into the sales pitch. Currently, MA plans are often compared based on premiums, co-pays, and provider networks. This new requirement adds a crucial metric: how likely the plan is to actually approve your doctor’s request for a service or drug in the first place.

For the average person managing a chronic condition, like someone needing regular physical therapy or specific medication, prior authorization can be a major headache. Plans use this process—often called utilization management—to ensure services are medically necessary. But when plans deny necessary care, it can delay treatment and force patients and doctors into time-consuming appeals. This bill pulls back the curtain on how often plans say “no” and, perhaps more importantly, how often they were wrong and had to reverse that decision.

What the Numbers Really Tell You

Imagine you’re comparing Plan A and Plan B. Plan A’s ad states they denied 10,000 prior authorization requests last year, but later approved 4,000 of them, taking an average of 35 days to reverse the decision. Plan B denied 5,000 requests and reversed 500, taking 10 days. These figures give consumers a powerful new way to judge a plan’s administrative burden. A high reversal rate (like Plan A’s) suggests the plan is initially denying a lot of necessary care, but eventually corrects itself—meaning more paperwork and delays for the patient. A low reversal rate might suggest the plan is more accurate in its initial denials, or simply harder to appeal.

This increased transparency is a major win for consumers. It forces plans to put their money where their mouth is, giving prospective enrollees the data needed to choose a plan that doesn't just look good on paper, but also has a track record of approving needed care without unnecessary delay. It also creates a public incentive for MA plans to streamline their prior authorization processes, because no plan wants to air an ad highlighting a high denial rate or a slow reversal time.