At The Orthopaedic Group, P.C., we’re committed to helping our patients make informed decisions about their healthcare coverage any how it affects their treatment here. Every year, more patients consider Medicare Advantage Plans because they’re marketed as convenient “all-in-one” options that combine hospital, medical, and drug coverage.
While these plans can seem appealing, many patients are surprised to learn that Medicare Advantage (Part C) plans often come with restrictions, limited access to specialists, and hidden costs that make them less ideal for those who need orthopaedic or other specialty care.
⚠️ The Challenges of Medicare Advantage Plans for Specialist Care
- Restricted Networks and Limited Choice
Unlike traditional Medicare, which allows you to see any provider who accepts Medicare, most Medicare Advantage plans use narrow networks.
That means your choice of orthopaedic specialists, imaging centers, or surgeons is limited to those in the plan’s contracted network—and if your provider isn’t in-network, coverage is often denied or significantly reduced. - Prior Authorizations Delay Care
Medicare Advantage plans frequently require prior authorization for imaging (like MRIs), physical therapy, and surgical procedures.
These approvals can take days—or even weeks—causing unnecessary delays for patients in pain or needing timely treatment. In orthopaedics, these delays can slow recovery, increase discomfort, and sometimes worsen outcomes.- This often limits the choices providers have in the beginning of treatment.
- Unexpected Out-of-Pocket Costs
Although many plans advertise low premiums, patients can face unexpected copays, coinsurance, and coverage denials when specialist care is needed.
For example, each imaging service, injection, or follow-up visit may carry a separate copay—even for care provided in a single episode of treatment. - Difficulty Accessing Specialized Imaging or Procedures
Orthopaedic practices often provide in-office MRI or X-ray services for convenience and continuity of care. Many Medicare Advantage plans require outside referrals or limit reimbursement for in-office imaging, forcing patients to schedule elsewhere—creating frustration and longer wait times.
💬 What This Means for Orthopaedic Patients
If you have chronic pain, arthritis, a fracture, or need surgery, it’s important to know that Medicare Advantage plans may restrict your ability to choose or stay with your preferred specialist.
Many patients discover too late that the plan they chose for convenience makes it harder to access the advanced, timely care they truly need.
At The Orthopaedic Group, P.C., we accept a wide range of insurance plans and are always transparent about what coverage we can honor. We strongly encourage patients to review all details carefully before enrolling in any plan that could limit access to your trusted specialists.
✅ Questions to Ask Before You Enroll
Before selecting or renewing a Medicare Advantage plan, ask:
- Is my orthopaedic specialist in-network for this plan?
- Does my plan require me to get a referral from my PCP before seeing a specialist?
- Will I need prior authorization for imaging or surgery?
- What are the out-of-pocket costs for each visit or procedure?
- Does this plan cover in-office imaging like MRI or X-ray?
If the answer to any of these is unclear, it’s worth reconsidering.
📍 Need Help Understanding Your Options?
Our patient services team is happy to help you understand your coverage and how it applies to specialist care.
Visit www.TheOrthoGroup.com or call (251) 476-5050 to learn more about which Medicare plans we accept and what to consider before making your next coverage decision.
