If you watch television or listen to the radio, you have
no doubt been bombard- ed with advertisements for Medicare Advantage plans. That is because Medicare's annual Open Enrollment period is here, running from Oct. 15 through Dec. 7. Be - fore you make a change, we want to share some infor- mation 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 sav - ings come with limits that can matter a great deal if your health changes.
**Your choice of doctors and specialists can be nar -
rower.** Traditional Medi- care is accepted by nearly every doctor and hospital in the country, with no net -
work 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 Tradi - tional Medicare, we simply call scheduling and pick a time. With most Medicare Advantage plans, your doc - tor must first get the insur - ance company's approval. This approval process can delay your scan by days and the plan can deny pay - ing for the scan altogether. Prior authorization is now part of nearly every Medi - care Advantage plan while Traditional Medicare rarely requires it.
**Rehabilitation and nursing care are fre -
quently denied.** If you are hospitalized and need rehabilitation to regain your strength, Medicare Advan - tage plans often deny that you need the service at all or make it hard to find a fa -
cility that will accept their payment. Independent gov - ernment reviews have found Medicare Advantage plans denying rehabilitation care that met Medicare's own criteria. Traditional Medi - care is accepted at hospi - tals, clinics, and rehab fa - cilities 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 lat -
er may be harder than you think.** If your health declines, you can return to Traditional Medicare
during Open Enrollment.
But in most states - in - cluding Texas - a Medigap supplement company can refuse you or charge you more because of pre-ex -
isting conditions. This can leave you facing Tradition - al Medicare's 20% coin - surance 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 Medi - care.
You can see why some of us call them Medicare *(Dis)advantage* plans. They may offer some ap pealing extras but it is important to understand what you may be giving up by handing your Traditional Medicare benefits to a pri -
vate, for-profit company.
**Still unsure which way to go?** Join us for *The ABCs of Medicare and Medicare Advantage Plans* on Nov. 4, 2026, at 10 a.m. in the Columbus Wellness Center Communi- ty Room. The program will give you the detailed infor - mation 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
