Important Insurance & Medicare Updates: What Patients Need to Know for 2026

At Arthritis & Osteoporosis Treatment Center (AOTC), your health and continuity of care are our top priorities. As insurance plans change from year to year, these updates can sometimes affect your medications, infusions, and even your ability to continue treatment at our office.

We want to make sure you have the information you need to make confident decisions — and avoid any disruptions in your care. 

How Insurance Changes Can Affect Your Medications

Many of our patients rely on specialty medications — either taken at home (self-injections or oral therapies) or given in our office (infusions). When switching plans, here are some common issues that can arise:

• Formulary differences: Each plan has its own preferred drug list. Your current medication may not be covered, or may require special approval.
• Step therapy: Some plans require you to try a different medication before approving the one you are stable on.
• Delays in treatment: New prior authorizations can slow down the approval process.
• Coverage loss: If our office is not in-network, your infusion or specialty medication may not be covered here.

Key takeaway: Always verify your medications and our office’s network status before making any insurance changes.

Medicare Advantage vs. Traditional Medicare

If you are eligible for Medicare, it’s especially important to understand the difference between Medicare Advantage and Traditional Medicare:

Medicare Advantage (Part C) Plans

• Run by private insurance companies.
• Our practice is not in-network with most Medicare Advantage plans.
• This means we may not be able to continue your care at AOTC if you enroll.
• Infusions and specialty medications may not be covered here.
• Many plans require prior authorization, which can cause treatment delays or denials.

Original (Traditional) Medicare (Part A & B)

• Fully accepted at our practice.
• You can add a Medicare Supplement (“Medigap”) plan to help with costs.
• Typically fewer barriers: Original Medicare patients usually do not face restrictive prior authorizations for rheumatology medications or infusions.

Enrollment Dates to Know

• Medicare Annual Enrollment Period: October 15 – December 7, 2025
  • Switch between Original Medicare and Medicare Advantage.
  • Make changes to Part D prescription drug plans.
  • All changes take effect January 1, 2026.
    
• Medicare Advantage Open Enrollment: January 1 – March 31, 2026
  • Switch to another Medicare Advantage plan or return to Original Medicare.

What You Should Do Before Making Changes

• Contact our office to review how a new plan may affect your medications and treatments.
• Verify with the new plan that your medications and infusion services will be covered.
• Make sure AOTC is in-network before you enroll.
• Notify us promptly of any insurance changes so we can coordinate your care.

We’re Here to Help

We understand that insurance decisions can feel overwhelming. Our team is here to answer your questions and guide you through the process to ensure your treatment continues smoothly.

Please call our office before making any changes to your insurance coverage.

Your care is too important to risk interruptions. Thank you for trusting Arthritis & Osteoporosis Treatment Center with your health.