17%
Average denial rate across all Marketplace plans
49%
Highest denial rate for a single insurer
40%
Appeals that succeed when appealed
0.1%
Share of denials that members actually appeal
Marketplace Plan Denial Rates
Based on KFF analysis of CMS Marketplace data. In-network claims only. Rates include all denial types.
Detailed Data Table
Click column headers to sort. Denial rates represent in-network claim denials as a percentage of all in-network claims.
| Top Denial Reason |
|---|
Data Methodology and Limitations
- Data is based on KFF analysis of CMS Marketplace Issuer Landscape and plan-level data from the most recent available reporting year
- Denial rates are for in-network services only; out-of-network denial rates are typically much higher
- Denial rates vary significantly by plan type, state, and service category — these are aggregate figures
- Appeal and overturn rates are estimates based on available CMS and regulatory data; actual rates may differ
- Insurers with very low claim volumes may show higher variance in denial rates
- These figures represent Marketplace (ACA) plans only — employer-sponsored plans are not required to report and typically report separately to the DOL
- Some insurers operate under multiple brand names; data may be consolidated at the parent company level
Source: KFF analysis of CMS Marketplace data; CMS Quality Rating System; state insurance department reports. Data updated annually. Last updated 2025.