State Detail

Maine

5 plans reporting · CY 2025

Across 5 plans reporting in Maine, standard prior authorization denial rates range from 6.3% to 16.5%, averaging 10.5%. Among plans reporting appeal outcomes, 87.0% of appealed denials are overturned. All data is from mandatory CMS-0057-F disclosures for calendar year 2025.

Plan Comparison

		Standard												Expedited
Plan	Org	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days	Requests	Approved	Denied	Appr %	Denial %	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days	Source
Centene Corporation
Wellcare Medicare Advantage (ME H2775)Medicare Advantage	Centene Corporation	151,140	126,266	24,874	83.5%	16.5%	2,224	94.2%	5.8%	0.0%	100.0%	4.0	1.0	21,698	18,478	3,220	85.2%	14.8%	362	97.0%	3.0%	0.0%	100.0%	1.0	1.0	View source ↗
Wellcare Medicare Advantage (ME H9364)Medicare Advantage	Centene Corporation	24,260	21,476	2,784	88.5%	11.5%	314	97.8%	2.2%	0.0%	100.0%	4.0	1.0	2,846	2,526	320	88.8%	11.2%	31	93.5%	6.5%	0.0%	100.0%	1.0	1.0	View source ↗
Wellcare Medicare Advantage (ME H2816)Medicare Advantage	Centene Corporation	1,635	1,466	169	89.7%	10.3%	20	90.0%	10.0%	0.0%	100.0%	4.0	1.0	40	38	2	95.0%	5.0%	1	100.0%	0.0%	0.0%	100.0%	0.0	0.0	View source ↗
Martin's Point Health Care
Martin's Point Generations Advantage LPPO (H1365)Medicare Advantage	Martin's Point Health Care	972	893	79	91.9%	8.1%	—	—	—	0.0%	100.0%	7.0	8.0	157	139	18	88.5%	11.5%	—	—	—	0.0%	100.0%	1.0	1.0	View source ↗
Martin's Point Generations Advantage HMO (H5591)Medicare Advantage	Martin's Point Health Care	14,729	13,803	926	93.7%	6.3%	199	65.8%	34.2%	0.0%	100.0%	7.0	8.0	2,326	2,169	157	93.3%	6.8%	—	—	—	0.0%	100.0%	1.0	1.0	View source ↗