By Kristin Carroll

Medicare Advantage (MA) plans, which cover a majority of Medicare enrollees, are denying or delaying medically necessary post-acute care with alarming frequency.

That’s according to a survey from the American Health Care Association (AHCA), the nation’s largest nursing home provider association. The survey went to 363 nursing home providers in May 2025.

Of these providers, 37% reported they received weekly denials, 29% reported daily denials, and 17% reported monthly denials.

The survey also found that 67% of skilled nursing providers had a patient’s coverage pulled too soon during their nursing home stay, often against medical advice.

“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, in a press release announcing the results. “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.”

These denials are usually overturned on appeal; 3% percent indicated denials were always overturned on appeal, and 54% indicated denials were sometimes overturned.

However, 32% of providers surveyed reported that appeals rarely worked in the patient’s favor.

A Senate report released last year found many MA plan managers are using artificial intelligence and complex algorithms to determine denials. The Senate report also found MA plan administrators denying prior authorization requests for post-acute care for enrollees at higher rates than for other types of care.

Major Medicare Advantage companies such as UnitedHealth Group (NYSE: UNH) and Humana (NYSE: HUM) are currently in litigation related to the use of AI to deny claims. And facing widespread pushback, 40 health insurance providers recently vowed to overhaul and streamline their prior authorization processes.

“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.”