New CMS-based analysis shows ACA claim denial rates range from 5% to 27% across the country, with significant variation by insurer, state, and marketplace structure.
Sources: CMS Transparency in Coverage Public Use Files (Plan Year 2024), CMS QHP Landscape File, CMS Medical Loss Ratio submissions, insurer-reported denial data, and KFF survey data; MoneyGeek analysis.
Full data tables & state/insurer breakdown:
moneygeek.com/insurance/health/aca-claim-denial-rates-by-state-and-insurer/
by mark-fitzbuzztrick
2 Comments
The website didn’t bother checking their tables. It can’t sort rates properly. It’s sorting it like strings and not as a number (probably because of the % at the end).
For anyone interested, in 2024, Hawaii has the worst deny rate (~27%), South Dakota has the best (~5%).
Two huge points from this, assuming the data and its analysis are legitimate:
> “Three in four denials (77%) stem from paperwork or plan design, not medical judgment.”
> “Consumers rarely appeal: fewer than 0.2% of denied claims were appealed internally, and 56% of those appeals were upheld.”