Aetna Medicare Advantage denial? What the numbers say, and how to appeal
Checked against the current rules on September 18, 2026.
A denial from Aetna — or any Medicare Advantage plan — follows the exact same federal appeal process. The plan doesn't get to set its own rules for how an appeal works; that's set by regulation.42 CFR 422.101
Denial rates and how often a plan grants prior authorization requests vary meaningfully by company — that's real, and worth knowing. What doesn't vary is your legal right to appeal, or the deadlines that apply once you do.
What the 2024 data actually shows
CVS Health reported that 19.9% of denied prior authorization requests were appealed in 2024 — separate from its overall denial rate, which KFF's report didn't break out for this company.KFF, Jan 28, 2026
Across all Medicare Advantage insurers combined, 11.5% of denials were appealed in 2024, and 80.7% of those appeals were overturned — the aggregate figure, not specific to any one company.KFF, Jan 28, 2026
The appeal process is identical across plans
Every Medicare Advantage plan — regardless of size or brand — has to give you at least 65 days to file a first-level appeal, and has to answer within 30 days for a service you haven't received yet, 60 days for a payment request, or 72 hours if expedited.42 CFR 422.582
If the plan upholds its own denial, it has to forward your case automatically to an outside reviewer — the same requirement applies to every plan.42 CFR 422.590
None of that changes based on which company issued the denial. A Aetna appeal and a smaller regional plan's appeal go through the identical five-level structure, with identical deadlines at every step.
Why a plan's denial rate matters anyway
A higher denial rate doesn't mean a specific denial from Aetna was wrong — but it does mean that, statistically, more of that company's requests are being turned down in the first place, which is exactly the kind of pattern that makes checking your own denial against the actual rule worthwhile rather than assuming it was decided correctly.
Where to send your appeal
Aetna's own appeals address or fax number is printed on your denial notice, usually under a heading like "How to appeal." Plan addresses vary by contract and change over time, so the notice itself — not a general web search — is the reliable source for where to actually send it.
If the notice is unclear or the address seems out of date, Aetna's member services line (also on the notice) can confirm where a reconsideration request should go.
Questions people ask
- Does Aetna have a worse appeal process than other plans?
- No — the appeal process itself is set by federal regulation and is the same for every Medicare Advantage plan. What varies by insurer is how often they deny requests in the first place, which is what the data above reflects.
- Where do these numbers come from?
- KFF's own analysis of CMS's published 2024 Medicare Advantage prior authorization data, covering all Medicare Advantage insurers required to report it.
Sources — last checked September 18, 2026
- 42 CFR 422.101as of September 18, 2026
- 42 CFR 422.582as of September 18, 2026
- 42 CFR 422.590as of September 18, 2026
- KFF, Jan 28, 2026
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By CaseWhy Appeals editorial. See how this content is produced. Not legal advice. Not affiliated with or endorsed by Medicare, CMS, or any health plan. A product of CaseWhy LLC.
