Medicare Advantage Isn’t an Advantage: What Providers Wish Patients Knew

Let me start with this. I’m not an insurance agent, and I don’t know every detail about every plan or coverage option out there. But I know some great people who do, and I’m always happy to connect you with trusted professionals if you have questions. That being said, when I was seeing a client yesterday, he got really excited about a commercial for a Medicare Advantage plan that was advertising a very low premium from a company that may or may not rhyme with banana. This particular company has caused me a few serious blood pressure issues this year when I was trying to get permission to see a client on their Advantage plan. Then, in the middle of our session, he got a phone call from another insurance company trying to get him to switch to an Advantage plan. I’ll be honest…I got fired up… again. So, now you get another Medicare-themed rant/blog post this month. Sorry not sorry.

Every year, I see more and more patients signing up for Medicare Advantage plans. The commercials make them sound amazing: low or no premiums, gym memberships, vision coverage, maybe even dental. On paper, it feels like a great deal. But what most people don’t realize until it’s too late is that these plans often make it harder to actually get the care you need.

The Hidden Headache of Authorizations

As a therapist, I’ve watched patients wait weeks for care that should have started right away. Medicare Advantage plans often require pre-authorization before almost everything. You need therapy? Authorization. You finish your first round of sessions and still need help? Another authorization. You want to change your treatment plan or try a new approach? Yet another authorization.

It’s a cycle that never ends. Each request can take days or weeks to process, and sometimes the insurance company decides you’ve had “enough therapy” even when you clearly haven’t reached your goals. Traditional Medicare doesn’t work that way. If your doctor and therapist agree that services are medically necessary, you can continue without constant interruptions and red tape.

What It Means for Your Coverage

Here’s the part that surprises most people. Medicare Advantage plans are managed by private insurance companies. Their goal is to control costs, which means limiting how much care you can receive, how often, and where you can go. Many switch patients from PPOs to HMOs, cutting access to hospitals, specialists, and even rehab centers.

I’ve had patients discover that the clinic or hospital they want to use “isn’t in network” or that certain therapies “aren’t covered.” Sometimes they find out after they’ve already received care and are stuck with the bill. Traditional Medicare, or Medicare with a supplement, doesn’t put you in that position. You can see any provider who accepts Medicare, anywhere in the country.

Why Providers Are Walking Away

You may have seen recent headlines about major hospitals like Mayo Clinic stepping away from some Medicare Advantage contracts. This isn’t a small issue. It’s happening nationwide because providers can’t sustain the low reimbursement rates and administrative demands. For clinics like mine, it means hours spent chasing paperwork instead of helping patients. For patients, it means fewer providers accepting their plan.

The Illusion of Savings

Medicare Advantage plans often seem cheaper upfront because the monthly premiums are lower. Those savings disappear fast when you actually need care. Out-of-pocket costs add up through higher copays, visit limits, and denied authorizations. Traditional Medicare with a supplement may cost a bit more each month, but it provides consistent, predictable coverage when you need it most.

What’s Happening Right Now

As we talk about Medicare and the tough choices that come with it, it’s worth looking at what’s happening right now. It’s October 24, 2025, and we’re in the middle of a federal government shutdown. Many of us therapists haven’t been paid for sessions we’ve already provided to Medicare patients in October. We’re still showing up, treating our patients, and doing the work, but payments are sitting in limbo. That’s the reality of the current system.

And while all this is happening, we’re in the middle of Medicare Open Enrollment. It’s the time of year when people can review their coverage and make changes that go into effect January 1. The 2025 Medicare Open Enrollment Period runs October 15 through December 7, and the Medicare Advantage Open Enrollment Period runs January 1 through March 31 (only if you’re already in a Medicare Advantage Plan).

This overlap makes it the perfect time to really think about what kind of coverage works best for you. If providers are already feeling the strain, imagine how much harder access could become for patients tied to restrictive plans.

Why This Timing Matters

Therapists and small clinics are already under pressure. When payments stop during a shutdown, it’s a financial hit most of us can’t absorb for long. When you add in Medicare Advantage’s lower reimbursement rates and constant pre-authorization requirements, it becomes nearly impossible to keep up. That’s why so many providers are stepping away from these plans, and it’s why patients often find themselves with fewer options.

The Bottom Line

Medicare Advantage plans promise more for less, but too often deliver less when it matters most. Traditional Medicare with a supplement gives you the freedom to choose your providers, continue therapy when needed, and avoid the endless authorization cycle. That’s real coverage….and that’s the kind of care every patient deserves.

If you’re old enough for Medicare, do your homework. If someone you love is Medicare-eligible, help them make a decision that’s informed. Sit down with a Medicare insurance expert…do not trust a TV commercial, or a flyer in the mail. There are several trusted agents right here in Omaha that I know personally and work with frequently, and I’m happy to share names if you need a place to start. Take the time to really understand what you’re choosing. Visit the official Medicare website, read the fine print, and make sure your plan truly supports your health, your freedom, and your access to care.

https://www.medicare.gov/basics/get-started-with-medicare