10/14/2025
Open enrollment is about to be LIVE!
As a provider we wanted to share a few common issues/misunderstandings we run into with patients pretty much on a daily basis regarding Medicare and Medicare Advantage Plans.
Even though advantage plans are a part of the part C of federal Medicare they DO NOT follow Medicare guidelines, instead they follow the guidelines of the commercial payer which would be your Aetna, Humana, UHC, etc. So when you sign up for an advantage plan, you DO NOT have traditional Medicare. Over the last few years, especially this last year, we continue to see barrier after barrier with advantage plans because they dictate your care and how you use it (which every insurance does, just ask your dr). Recently I’ve had UHC Advantage reps deny PT for post op care of TKA, or Parkinson’s diagnosis with frequent falls because “those diagnoses just don’t justify skilled need.” These are just a few to paint a very small picture for you.
We understand health insurance can be confusing and messy, and everyone has to choose plans they can afford but please, please, PLEASE do your due diligence and know exactly what you are signing up for with Medicare and the advantage plans. Ask questions! Then ask more questions!!!
