I've Written So Many Appeal Letters This Year… Let’s Have a Chat About Medicare Advantage Plan's and Who’s the Advantage Really For?

It’s July, and I’ve already written more insurance appeal letters this year than I care to count.

If you’re a patient, you probably don’t see that part of my job—the back-and-forth with insurance companies just to justify medically necessary care. But trust me, it’s happening. And if you’ve got a Medicare Advantage plan, chances are you’ve felt the effects.

Let’s talk honestly for a minute.

If you’re approaching 65 or helping a loved one with their Medicare decisions, you’ve probably seen ads for Medicare Advantage plans promising “more benefits,” “all-in-one coverage,” and even free gym memberships. Sounds great, right?

Here’s the truth: unless you fall into a very specific group, Medicare Advantage plans often don’t provide an advantage for the consumer at all—and can actually limit your access to care when you need it most.

Let’s break it down.

🔍 What Is a Medicare Advantage Plan?

Medicare Advantage (also known as Medicare Part C) is a type of Medicare-approved plan from a private insurance company that contracts with Medicare to provide your Part A and Part B benefits. These plans replace your traditional Medicare, and usually come bundled with Part D (drug coverage) and extra benefits like dental or vision.

🧠 Sounds Convenient… So What’s the Catch?

The short answer? Control.When you enroll in a Medicare Advantage plan, your healthcare decisions are no longer primarily between you and your doctor—they’re now dictated by insurance company rules, prior authorizations, and network restrictions.

Here’s how that plays out in real life:

🚩 1. Limited Provider Networks

Many Advantage plans use HMO-style networks. That means you can’t see just any provider—you’re limited to doctors, specialists, and therapists in-network, even if there are better or more experienced options nearby.

In rural areas like Tipton County, that often means fewer choices and longer wait times.

🚩 2. Delays in Care

Need physical therapy? A specialist visit? Imaging? You may need pre-authorization—and you may get denied. Even for medically necessary treatment, Advantage plans often limit the number of visits or require you to “fail” less expensive options first.

We see this all the time in the clinic: patients who need help now, but are stuck in limbo waiting for insurance to say yes.

🚩 3. Hidden Costs

While Advantage plans sometimes have lower premiums than traditional Medicare with a supplement, they often have higher out-of-pocket costs when you actually use them. You may face:

• Copays for every therapy visit

• Out-of-pocket costs for out-of-network care

• Surprise bills after denied authorizationsIt adds up quickly—especially if you need consistent care or have a chronic condition.

  
  

🚩 4. Short-Term Perks, Long-Term Headaches

Yes, some plans offer dental, vision, or gym memberships. But these benefits can’t make up for delayed or denied access to essential healthcare. It’s a classic case of giving you a little upfront… while taking away control over the big things that matter.

✅ So Who Does Medicare Advantage Work For?

There are certain situations where Advantage plans may make sense—like:

• If you’re in excellent health and rarely need medical care

• If your preferred doctors and providers are in-network

• If you understand the limitations and are okay with themBut if you want choice, speed, and consistent access to high-quality care, traditional Medicare plus a supplemental (Medigap) plan is often the far better option.

  
  

💬 Why This Matters at My Clinic

As a Fellowship-trained physical therapist, my goal is to give my patients the best care possible, without unnecessary barriers. Unfortunately, I see every week how Medicare Advantage plans create delays, denials, and confusion for patients who just want to get better.

We work hard to advocate for you—but at the end of the day, Advantage plans give insurance companies the final say.

🤔 What Can You Do?

• Research before you enroll. Don’t just listen to the commercials—talk to someone who understands the system.

• Ask your providers what plans they accept—and whether they’ve had issues with Advantage plans.

• Consider traditional Medicare + a Medigap plan for more freedom and fewer delays.

• Call us if you have questions. We’re happy to talk through your options and help you understand how your plan affects your access to care.

  
  

🎯 Final Thought

Medicare Advantage plans might seem like a good deal—but for many people, they end up costing more in time, money, and missed care. The “advantage” isn’t always yours.