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Aetna (CVS Health): Medicare Advantage denial & appeal rates
CVS Health / Aetna · 12% of MA enrollment
In 2024, Aetna (CVS Health) denied about 11.6% of the prior-authorization requests it reviewed. When members appealed, 92.6% of those denials were overturned — yet only 21.4% of denials were appealed at all. about 8 in 10 appealed Medicare Advantage prior-authorization denials are overturned, fully or in part (KFF, 2024 data), so a denial is rarely the final word.
Aetna (CVS Health)’s posted coverage policies
Insurers must post the medical policies they use to decide coverage. These are the ones most relevant to lab, imaging, and facility denials — quote the matching policy in your appeal.
Aetna (CVS Health)’s CMS prior-authorization metrics posting →
Denied by Aetna (CVS Health)? Don’t pay a bill you may not owe.
Most denials are never appealed; the published figures for those that are are on the scorecard. See how the deadlines and the process work, or fast-track a rehab/nursing discharge.
Insurer / contract level. Medicare does not publish per-plan denial rates. Rates are 2024 prior-authorization determinations (KFF analysis of CMS contract-level data). Data as of September 2026. Notes: Highest appeal share (21.4%; prose 'one in eight'/19.9%). Denial rate now filled from KFF chart dataset (was blank in prose). CY2025 per-contract PDF has ~40 H-numbers (see contract-samples sheet). Informational only — not medical, legal, or billing advice.