Health Plans Must Start Posting Prior Authorization Stats by March 31, 2026: What Patients Should Look For

Starting today, March 31, 2026, some health plans and public programs must begin posting new prior authorization statistics from calendar year 2025 on their public websites. For patients and families, that means some data that used to be hard to compare may now be easier to find.

The new postings will not tell you everything about a plan. They do not cover every private insurer in the United States, and they do not include prescription drug prior authorization. But they can still give you a clearer picture of how often requests are denied, how often approvals happen only after appeal, and how long decisions usually take.

What changed on March 31, 2026

March 31, 2026 is the first deadline for certain payers to publicly post prior authorization metrics from the previous calendar year. In plain terms, affected plans now have to show 2025 data on their websites.

Prior authorization is the process insurers and health programs use when they require approval before covering some medical services, equipment, tests, or treatments. If you have ever been told that your scan, procedure, or therapy visit needs insurer approval first, that is prior authorization.

The new public reports are meant to add transparency. They give patients, caregivers, clinicians, and advocates a way to see broad patterns in how prior authorization worked over the year.

Which health plans and programs must post the data

The rule does not apply to every health plan in America. It applies to specific payer types regulated under this policy:

Medicare Advantage plans
State Medicaid fee-for-service programs
State CHIP fee-for-service programs
Medicaid managed care plans
CHIP managed care entities
Qualified Health Plan issuers on the federally facilitated exchanges, including plans sold through HealthCare.gov in states that use the federal marketplace

That means some employer-sponsored plans, many off-exchange commercial plans, and other private coverage arrangements may not be part of this reporting requirement.

The 5 numbers and lists patients should check first

If your plan or program is covered, start with these items on the website report.

1. The list of services that require prior authorization

This may be the most practical place to start. The report should include a list of medical items and services that require prior authorization. That can help you spot common trouble points before you schedule care.

If you know you may need imaging, outpatient surgery, rehabilitation, home equipment, or another high-cost service, check whether it is on the list. The report should be about medical items and services only, not drugs.

2. The denial rate

Look for the share of standard and expedited requests that were denied. A higher denial rate does not automatically prove a plan is worse, because the posted data are broad and combined across many different services. Still, the denial rate is one of the clearest numbers to watch when you are comparing plans or trying to understand a delay.

3. The approval rate

The approval rate shows how often requests were approved overall. On its own, this number can look reassuring, but it is more useful when you read it next to the denial rate, appeal information, and response-time data.

4. Approvals after appeal

This is an especially useful number. If a sizable share of requests are approved only after appeal, that may suggest some initial denials do not hold up. It does not prove the first decision was wrong in every case, but it can be a sign that patients and providers should not assume an initial denial is the final word.

Keep in mind that these appeal figures are still broad. They are not broken down service by service, and they combine appeal activity at multiple levels rather than showing a detailed case history.

5. Average and median response times

Patients should also look at how long decisions typically take. The new reports are designed to show both the average and the median time between a request being received and a decision being made, for standard requests and for expedited requests.

The median can be especially helpful because it is less affected by a small number of unusually slow cases. If the average is much higher than the median, that can hint that some requests took much longer than most others.

Also check whether review timeframes were extended

The reports should also show how often the timeframe for review was extended and the request was later approved. That matters because an extension can mean more waiting for care, even when coverage is eventually granted.

Why the reporting level matters

Not every report describes the same size population.

Medicare Advantage data are reported at the contract level
Medicaid and CHIP fee-for-service data are reported at the state level
Medicaid managed care and CHIP managed care data are reported at the plan level
HealthCare.gov marketplace data are reported at the issuer level

That matters because a large contract or issuer can include multiple products or local networks. So even when the numbers are useful, they may not reflect the exact experience of one neighborhood, one hospital system, or one type of service.

What the new data can and cannot tell you

These reports can help, but they have important limits.

What they can tell you:

Whether a plan required prior authorization for many services or relatively fewer services
How often requests were denied in the aggregate
How often approvals happened after appeal
How long decisions usually took
Whether extensions of review timeframes were part of the process

What they cannot tell you:

How a plan handled one specific service, diagnosis, or doctor
Whether a denial was clinically appropriate in an individual case
How easy or difficult it was for patients to complete the appeal process
What happened with prescription drug prior authorization, which is outside this reporting set

Another big limit is that the numbers are aggregated across all covered medical items and services. That means a report can hide important differences between, for example, imaging requests and post-acute care requests.

The appeal numbers are limited too. They aggregate appeals across levels rather than showing where in the process a reversal happened.

What about decision deadlines?

Under the policy, impacted payers other than HealthCare.gov marketplace issuers on the federally facilitated exchanges are generally required to send decisions within 72 hours for expedited requests and 7 calendar days for standard requests.

It is worth being precise here: the public reporting requirement includes marketplace issuers on the federal exchange, but the same decision-timeframe rule in this policy is not applied to those marketplace issuers in the same way. Patients should avoid assuming every plan shown in the new reports follows identical response deadlines.

How to use the information when choosing coverage or facing a delay

If you are comparing plans, these new postings can give you a few useful questions to ask:

How many services require prior authorization?
How often are requests denied?
How often are denials reversed on appeal?
How long do standard and urgent decisions usually take?

If you are already dealing with a delay, the reports can also help you prepare:

Ask whether the service you need is on the plan’s prior authorization list
Request the specific reason for any denial
Keep records of phone calls, portal messages, letters, and dates
Ask your clinician’s office whether more documentation could help
If an appeal is available, ask about the deadline and required steps right away

The public numbers do not prove what will happen in your case. But they may help you spot patterns, ask more informed questions, and document concerns if care is delayed.

Why prior authorization remains a major patient issue

Even with the new transparency rules, prior authorization remains a major source of frustration for patients and clinicians. Recent national reporting has shown that Medicare Advantage insurers handled tens of millions of prior authorization requests in 2024, denied millions of them, and overturned most appealed denials. Separate physician survey data suggest doctors continue to report delays, treatment disruption, and patient harm tied to prior authorization, though those survey findings reflect physician experiences rather than a direct count of patient outcomes across all plans.

That is why the new postings matter. They do not fix prior authorization by themselves, but they may give the public a better window into how often delays and denials happen.

What this means for readers

As of March 31, 2026, some patients can now check plan websites for prior authorization data that were not previously easy to compare. The most useful numbers to start with are the denial rate, the share approved after appeal, the usual response times, and the list of services that need prior authorization.

Use the new reports as a transparency tool, not a final verdict on a health plan. One year of aggregated data cannot capture every patient experience. But if you are choosing coverage, planning care, or dealing with a delay, these new postings may help you ask sharper questions and push for clearer answers.

Sources

This article is for general informational purposes only and is not medical advice. Research findings can be early, limited, or subject to change as new evidence emerges. For personal guidance, diagnosis, or treatment, consult a licensed clinician. For current outbreak or public health guidance, follow your local health department, the CDC, or another relevant public health authority.