Navigating the world of retiree health care can be a challenge with countless carriers and plans available. Carriers can differ widely, not just in the kinds of benefits they offer, but also how they operate and process claims.

Recently, there has been news coverage of Medicare Advantage plans—comprehensive plans from private insurers that combine Medicare Part A and Part B with Part D prescription coverage—and their use of prior authorization to approve or deny certain types of care.

Insurance companies sometimes require prior authorization before a doctor can provide treatment to a patient, often for very expensive or complicated procedures. A common complaint about the prior authorization process is that it can lead to delays in care. Insurance carriers, on the other hand, argue it’s an important part of making sure patients are receiving appropriate treatment.

In a recently released report, KFF (formerly the Kaiser Family Foundation) analyzed Medicare Advantage data from the Centers for Medicare & Medicaid Services for the year 2023 and compared insurance carriers on their use of prior authorizations. That analysis included UnitedHealthcare and Kaiser Permanente, both of which provide PERACare Medicare Advantage plans.

The KFF analysis found that while UnitedHealthcare’s prior authorization denial rate was in the middle of the pack (9.1%), the company averaged just one prior authorization request per member for the year, which was the second-lowest among all carriers. Kaiser Permanente had a denial rate of 10% and averaged 0.5 prior authorization requests per member.

It’s important to note that medical providers initiate prior authorization requests, not patients. Patients with questions about prior authorizations should first reach out to their doctor and then the insurance carrier if any questions remain. For PERACare questions that remain unanswered, PERA may be able to further research the issue with the carrier.

Selecting a health care plan is a complex decision with many important factors to consider, including provider networks, premiums, deductibles, out-of-pocket maximums, and more. At Colorado PERA, we strive to select PERACare carriers that provide a high level of coverage and large provider networks while balancing cost. We encourage our members to examine all options available to them before choosing a plan that fits their needs.

Learn more about PERACare plans at copera.org/peracare.

Learn more about prior authorization on UnitedHealthcare’s website or Kaiser Permanente’s website.