Medicare Advantage

Extended Definition

Medicare Advantage (MA) plans, also called Part C, are an alternative way to receive Medicare benefits. Private insurance companies contract with Medicare to provide all Part A and Part B benefits, often with additional coverage.

How It Differs from Traditional Medicare

Feature	Traditional Medicare	Medicare Advantage
Provider network	Any Medicare provider	Usually network required
Prior authorization	Rarely needed	Often required
Cost structure	20% coinsurance	Copays (vary by plan)
Extra benefits	None	Often dental, vision, etc.
Medigap eligible	Yes	No
Referrals	Not needed	May be required

MA and Joint Pain Treatment

Potential Benefits:

• Lower premiums (some $0 plans)
• Out-of-pocket maximums (cap on spending)
• Additional benefits

Potential Challenges:

• Prior authorization for HA injections
• Network restrictions limit provider choice
• May deny or delay treatments
• Appeals process can be lengthy

Prior Authorization in MA

Many MA plans require pre-approval for:

• Hyaluronic acid injections
• MRI and advanced imaging
• Physical therapy beyond initial visits
• Certain DME items

Tips:

• Ask about PA requirements before scheduling
• Have your doctor’s office submit early
• Know your plan’s appeal process

Choosing Between MA and Traditional

MA may be better if:

• You want lower monthly premiums
• You don’t mind network restrictions
• You want extra benefits
• Your preferred providers are in-network

Traditional may be better if:

• You want any Medicare provider
• You travel frequently
• You prefer predictable costs (with Medigap)
• You want fewer treatment barriers