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If you watch television or listen to the radio, you have no doubt been bombarded with advertisements for Medicare Advantage plans. That is because Medicare’s annual Open Enrollment period is here, running from October 15 through December 7, 2026. Before you make a change, we want to share some information to help you make an informed choice about your health coverage.
MEDICARE ADVANTAGE IS NOT THE TRADITIONAL MEDICARE YOU HAVE KNOWN FOR YEARS.
A Medicare Advantage plan is a contract between you and a private insurance company that is paid by the government to manage your care — while still earning a profit. For healthy people who rarely need care, these plans can offer extra benefits and low premiums. But those savings come with limits that can matter a great deal if your health changes.
YOUR CHOICE OF DOCTORS AND SPECIALISTS CAN BE NARROWER.
Traditional Medicare is accepted by nearly every doctor and hospital in the country, with no network restrictions. Medicare Advantage plans use limited networks. In rural areas like ours, those networks tend to be especially narrow. Rural Medicare Advantage networks include roughly a third of area physicians. In practice, that can mean being sent to a specialist you do not know on the far side of Houston instead of the trusted specialists who come to our community.
CARE CAN BE DELAYED BY PRIOR AUTHORIZATION.
Suppose you come in with abdominal pain and your doctor orders a CT scan to find the cause. With Traditional Medicare, we simply call scheduling and pick a time. With most Medicare Advantage plans, your doctor must first get the insurance company’s approval. This approval process can delay your scan by days and the plan can deny paying for the scan altogether. Prior authorization is now part of nearly every Medicare Advantage plan while Traditional Medicare rarely requires it.
REHABILITATION AND NURSING CARE ARE FREQUENTLY DENIED.
If you are hospital ized and need rehabilitation to regain your strength, Medicare Advantage plans often deny that you need the service at all or make it hard to find a facility that will accept their payment. Independent government reviews have found Medicare Advantage plans denying rehabi l itat ion care that met Medicare’s own criteria. Traditional Medicare is accepted at hospitals, clinics, and rehab facilities nationwide whereas Medicare Advantage plans are tied to a service area. We even see patients who live nearby but whose plan “stops at the county line” and will not cover care in Columbus.
SWITCHING BACK LATER MAY BE HARDER THAN YOU THINK.
If your health declines, you can return to Traditional Medicare during Open Enrollment. But in most states — including Texas — a Medigap supplement company can refuse you or charge you more because of pre-existing conditions. This can leave you facing Traditional Medicare’s 20% coinsurance with no cap or you could be stuck in a plan that no longer meets your needs.
THE PAPERWORK IS RELENTLESS.
Our offices spend considerable time on websites, phone calls, and forms simply trying to get you the care your Medicare Advantage plan already promised. This is not the case with Traditional Medicare.
You can see why some of us call them Medicare *(Dis) advantage* plans. They may offer some appealing extras but it is important to understand what you may be giving up by handing your Traditional Medicare benefits to a private, for-profit company.
STILL UNSURE WHICH WAY TO GO?
Join us for *The ABCs of Medicare and Medicare Advantage Plans* on November 4, 2026, at 10:00 a.m. in the Columbus Wellness Center Community Room. The program will give you the detailed information you need to make a confident decision for this year’s enrollment period.
Toward your continued good health, Carl Dahlberg, MD · Bart Klaus, MD · Troy Millican, MD · David Neisner, MD · Rosemary Buckle, MD · Sharin Hjella, DO · Ashraf Allahwala, MD
