Health coverage in America, by the numbers

The denial and appeal records

1. Denials and appeals: CMS Transparency in Coverage public use files, plan years 2022 to 2026, which report claims from 2020 to 2024. Individual-market medical plans only, in states using HealthCare.gov. Insurers report these figures to CMS themselves. Numbers are FHI's totals of issuer-level figures, not CMS's own, and closely match KFF's 2024 analysis (KFF leaves out insurers with 1,000 or fewer claims, so it counts 39 fewer appeals). The headline figures count in-network claims, as KFF does: 84.5 million denials in 2024, 19% of in-network claims, and 263,021 internal appeals, about 1 for every 320 of those denials. The map and the trend chart open on in-network claims too. The trend chart can switch to out-of-network claims or all claims, and the map to all claims; the insurer table counts in-network claims only. Cells CMS suppresses for small counts are left out.

Why should I appeal?

1. Source: the denial and appeal records above.
2. Appeals: the counts aren't split by network, so the 1-in-320 figure compares two totals, as KFF's does. Appeal win rates count only insurers that reported both appeals filed and appeals won, and an appeal won in part counts as won. Nine insurers' 2024 appeals-won counts look like reporting errors, so we leave them out too. Four reported none of their 346 to 1,813 appeals won, after winning a quarter to nearly half the year before. For three, CMS marked the win rate as suppressed but printed the counts anyway. Two reported exactly the same counts as in 2023. Their appeals still count as filed. With them, the 2024 rate would be 33.6%. We show only the latest year's win rate, because the insurers reporting change from year to year.
3. Independent medical review: California DMHC IMR determinations, via the CalHHS Open Data Portal, 2010 to 2025 (file as published June 2026), with exact duplicate records removed. That's the step after an insurer's own appeal. Its rate isn't directly comparable with the insurers' own appeal results: different plans, people and review processes.

Back to Why should I appeal?

Who is denying the most?

1. Source: the denial and appeal records above.
2. State map: Grey states run their own marketplace, so their insurers don't report to HealthCare.gov and aren't shown. That now includes Georgia and Illinois, which used HealthCare.gov in 2024 but have since moved to their own, so their 2024 claims aren't here either. A state that a view leaves out has an outlined tile, and the line under the map says why. In Wyoming one insurer reports, and in Hawaii, Alaska, West Virginia and Montana two do, so those states' figures are those companies' figures. The small type on each tile, shown when the map is wide enough, is the lowest to the highest rate among that state's insurers in the insurer table. The map opens on in-network claims, and we don't map out-of-network claims by state (see What are they denying? below).
3. Insurer table: Each reporting HealthCare.gov insurer that handled at least 50,000 in-network claims in 2024. These are unadjusted rates, not a quality rating: they depend on the kinds of care each plan's members use and how each company counts claims. Appeal win rates are shown only for insurers with at least 30 appeals, and "not reported" means CMS withheld the number won or we left it out as a likely reporting error (see Why should I appeal? above). Why there are no out-of-network or all-claims rates: see What are they denying? below.
4. Prior authorization: each insurer's or state's own 2025 report, posted under the CMS prior authorization rule, copied as posted with a link to the source for every row. Reports whose scope or units weren't clear are left out. We gathered them from insurers' and states' own websites.
5. Prior authorization deadlines: the rule as published in the Federal Register (CMS-0057-F, February 2024) and the regulations for each kind of plan: 42 CFR 422.122, 422.568 and 422.572 (Medicare Advantage), 440.230 and 431.80 (state Medicaid), 438.210 and 438.404 (Medicaid plans), 457.495 and 457.1230 (CHIP), and 45 CFR 156.223 and 147.136 (HealthCare.gov insurers). Insurers in states that run their own marketplace through HealthCare.gov aren't covered. Medicaid plans' deadlines start with their first contract year beginning on or after January 1, 2026. A state-run CHIP program may follow its state's existing prior authorization law instead. CMS proposed adding prescription drugs in April 2026; we found no final rule. Checked October 18, 2026.

Back to Who is denying the most?

What are they denying, and why?

1. Source: the denial and appeal records above.
2. In network and out: CMS's data dictionary defines the one claims count in the files for 2020 and 2021 as in-network only, so the other two views start in 2022. In 2024 insurers denied 16.4 million of 44.4 million out-of-network claims (37%) and 100.8 million of 494.7 million claims overall (20%), the same national rates KFF reports. For 8.6 million of those out-of-network denials, about half, insurers gave the reason that the plan doesn't cover care outside its network (CMS's closed-network reason, reported per plan; one claim can count under more than one reason). KFF doesn't break out-of-network rates down by state or insurer, and we don't map them by state: in 2024, 120 of the 157 insurers reporting them sold only HMO or EPO plans (from CMS's 2024 plan list), which mostly don't cover out-of-network care by design, so a state's rate would mostly show which kinds of plans its insurers sell, not how they handle claims. We don't show them insurer by insurer either: even among insurers that also sold PPO or POS plans, many had most of their out-of-network claims on HMO or EPO plans, or gave that closed-network reason for most of those denials. The insurer table has no all-claims rates for the same reason: they fold in those out-of-network denials, so an insurer whose plans mostly don't cover out-of-network care could rank worse for that alone. Two insurers reported more out-of-network denials than claims in 2024, which can't be right: Moda Health Plan in Alaska and Blue Cross Blue Shield of North Dakota. We leave them out of the out-of-network and all-claims figures, and the map's all-claims view shows no figure for Alaska or North Dakota. Blue Cross and Blue Shield of Kansas (2022 claims) and Blue Cross Blue Shield of North Dakota (2023) are left out of those years the same way. There's no out-of-network change from 2023, which mostly reflects which insurers reported, and no out-of-network appeals figure. The states and insurers that report change each year (Georgia and Illinois have since left HealthCare.gov, and insurers that leave stop reporting), and rates aren't adjusted for the kinds of care people used.
3. Denial reasons: reported per plan for in-network claims, and one claim can count under several reasons, so they're shown as shares of reasons; like KFF, we leave out CMS's closed-network reason, covered above.

Back to What are they denying, and why?

Who doesn't have coverage?

1. Uninsured: Census Small Area Health Insurance Estimates, under 65, 2023 and 2024. The national figure adds up the state estimates.
2. Uninsured and health: compared across 48 states and DC (Kentucky and Pennsylvania have no 2023 estimates). The uninsured rate goes with the share of adults in fair or poor health (correlation 0.52), less with diabetes (0.36), and not with depression (-0.10).
3. Health measures: CDC PLACES county data, 2025 release (mostly 2023 BRFSS). Adult crude prevalence, county estimates weighted by adult population. Kentucky and Pennsylvania have no 2023 estimates in this release. Use of CDC data does not imply CDC endorsement.

Back to Who doesn't have coverage?

Drug costs

1. Drug spending: CMS Medicare Part D Spending by Drug, 2020 to 2024. Gross spending: what Medicare, plans and patients paid together, before manufacturer rebates. CMS marks some names with an asterisk where spending per dose mixes routes of administration; no per-dose figure is shown here, so the mark is left off. The short "for" label next to each drug is its main approved use, checked against MedlinePlus or the drug's FDA label; many drugs have other uses too.
2. Medicare prices: CMS's selected drugs and negotiated prices, with its 2026 fact sheet, 2027 fact sheet and 2028 fact sheet. CMS removed Xarelto from the list from January 1, 2027, because a generic is marketed, and is due to publish the 2028 prices by November 30, 2026. The price plans pay can't exceed the negotiated price plus a dispensing fee, and your share is based on it (CMS guidance). Ozempic's price also covers Rybelsus and Wegovy. Checked October 18, 2026.
3. Medicare drug help: the out-of-pocket cap from CMS's 2027 rate announcement (table V-2) and Medicare.gov's pages on drug costs, Extra Help and the Prescription Payment Plan. Checked October 18, 2026.

Back to Drug costs

Everything else

1. Today's counter: 2024 in-network marketplace denials divided by 366 days, counted up from your local midnight. It spreads a yearly total evenly for illustration; it isn't a count of denials happening today.
2. Open enrollment: Medicare's dates from CMS's announcement (September 28, 2026) and Medicare.gov. HealthCare.gov's 2027 sign-up window is in a court case, so we link to HealthCare.gov rather than print its dates. Checked October 18, 2026. Oregon's move to its own marketplace is from HealthCare.gov's state page, and insurers leaving the marketplace for 2027 from KFF's tracker, checked October 19, 2026.
3. Claim files: free from employer and marketplace plans under the federal claims rules (29 CFR 2560.503-1 and 45 CFR 147.136) and from Medicaid plans (42 CFR 438.406). Medicare Advantage and drug plans may charge a reasonable amount for copying and mailing, under section 50.5.2 of CMS's appeals guidance. Checked October 19, 2026.
4. Phone numbers and other sites: each taken from the office's or group's own page, checked October 18, 2026.