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A new analysis reveals a striking reality: health insurers 19% claims refusal has become a defining feature of coverage on the federal exchange, leaving millions navigating a maze where approvals can feel like a coin toss.

Denial Rates Hit Persistent Highs

According to a report from Kaiser Family Foundation, insurers rejected nearly 1 in 5 in-network claims in 2024—a 19% denial rate that matches 2023 as the highest level recorded since the Affordable Care Act marketplaces launched in 2015.

While denial rates have hovered within a narrow band over the years, they dipped to a low of 14% in 2018 before climbing again—suggesting a system under steady, mounting strain.

Insurers With the Highest Rejection Rates

Several major carriers led the list of claim denials, including Oscar Health, Molina Healthcare, Florida Blue, Community Health Choice, Cigna and BlueCross BlueShield of Tennessee.

Oscar Health posted the steepest increase, with denial rates surging from 17% in 2023 to 25% in 2024. Molina Healthcare followed with a 22% rate, though its figure declined from 26% the year prior.

A System Few Challenge

Despite the high rejection rates, the report found that fewer than 1% of patients appealed denied claims. Of those who did, insurers upheld the original decision in 66% of cases—highlighting how rarely denials are overturned.

Like a locked door with a narrow keyhole, the appeals process appears daunting, with most consumers choosing not to challenge the outcome.

Variations Across Plans and States

The data showed that denial rates vary depending on plan type. Catastrophic plans had slightly higher denial rates at 22%, while Gold-tier plans saw lower rates at 17%.

Geographic differences were also stark. Insurers in Hawaii declined 27% of in-network claims—the highest rate—while carriers in South Dakota and New Hampshire rejected just 7%.

Why Claims Are Denied

The most frequently cited reason for denials was categorized as “other,” followed by administrative issues, which accounted for 25% of rejections. Additional causes included excluded services (13%), lack of prior authorization (9%), and determinations tied to medical necessity or benefit limits (5%).

Affordability Pressures Intensify

The findings land amid growing concern over healthcare affordability, especially after the expiration of key ACA subsidies in December 2025, which contributed to declining enrollment.

As costs rise and coverage becomes more complex, the health insurers 19% claims refusal rate stands as a stark reminder: for many Americans, having insurance does not always guarantee access to care.