The Big Insurance Shake-Up: Don’t Let It Surprise You in 2026

October 24, 2025

Each fall, individuals and families across the country review their health insurance options—whether through an employer, the Marketplace, or Medicare. The numbers can be confusing, and many plans that look inexpensive up-front end up costing far more when you actually need care.

A recent headline from Minnesota serves as an important reminder to look beyond monthly premiums.

Mayo Clinic’s Big Announcement: A Warning for Medicare Advantage Members

Starting January 1, 2026, Mayo Clinic—one of the world’s most respected medical centers—will no longer be in-network for most UnitedHealthcare and Humana individual Medicare Advantage (MA) plans.

• UnitedHealthcare has said that its employer group retiree MA plans will keep access.
• Humana cited Mayo’s higher reimbursement rates as the reason for the split.
• Mayo confirmed it will continue to accept Original Medicare.

That means anyone who wants guaranteed access to Mayo must have Original Medicare (Parts A & B)—ideally paired with a Medicare Supplement (Medigap) policy.

This decision highlights a larger national issue: hospitals and clinics are increasingly walking away from private Medicare Advantage contracts that no longer make financial sense. And when that happens, patients lose access.

The Hidden Costs of “Low-Cost” Medicare Advantage Plans

Medicare Advantage plans can appear appealing because of their low or even zero-dollar monthly premiums. But these plans often come with trade-offs:

• Narrow provider networks – Your favorite doctors or hospitals may no longer be covered.
• Frequent prior authorizations – Services like imaging, physical therapy, or specialty visits may require approval, delaying care.
• Unpredictable costs – Instead of a stable Medigap premium, you may face numerous copays, coinsurance, and deductibles that make budgeting difficult.
• Limited flexibility when traveling – Many MA plans are regional HMOs, with little or no coverage outside your service area.

Original Medicare + Medigap typically costs more monthly but offers freedom of choice, predictability, and nationwide access—without worrying about which hospital or clinic is “in network.”

For Everyone Selecting Coverage (Not Just Medicare Members)

If you’re choosing a plan through your employer or the Marketplace, the same principles apply. The lowest premium doesn’t necessarily mean the lowest cost—or the best coverage.

Here’s what to check before you enroll:

1. Network Access
   Confirm your preferred doctors, hospitals, and clinics are in-network. If you travel or split time between areas, make sure your plan covers both.
2. Out-of-Pocket Exposure
   Look beyond the premium. Review the deductible, copays, and coinsurance. Run “what if” scenarios—what would you pay in a healthy year versus a year with unexpected medical needs?
3. Physical Therapy Benefits
   If you or a family member may need physical therapy, check:
   • How many visits are covered per year
   • Whether you need a physician referral or prior authorization
   • Your per-visit copay or coinsurance
   • If New Life Physical Therapy is in-network
4. Preventive & Wellness Coverage
   Verify coverage for annual exams, screenings, and wellness visits. Great health plans invest in prevention, not just crisis care.
5. Specialized Services
   Look at coverage for imaging (MRI, ultrasound), durable medical equipment, or mental health visits—all areas that can vary widely between plans.

A Smart Option Many People Overlook: Value-Based Self-Pay

If you don’t expect to reach your deductible in the coming year, or your favorite providers go out of network, it may make sense to ask your current providers about self-pay pricing.

Many high-deductible insurance plans require you to spend thousands before coverage even begins. In those cases, you’re essentially paying out of pocket anyway—but often at inflated, insurance-based rates.

At New Life Physical Therapy, for example, self-pay options are available at a time-of-service discount—often making care more affordable than going through most insurances until your deductible is met.

Self-pay can offer:

• Transparent, upfront pricing
• No surprise bills later
• Freedom to choose your provider
• The ability to start care immediately—without waiting for authorizations or approvals

If you’re trying to budget wisely for your health, asking about self-pay discounts or package options is one of the best ways to get high-quality, personalized care at the most value-based rate.

The Bottom Line

Whether you’re choosing Medicare coverage or an employer plan:

• Don’t choose based only on the monthly premium.
• Compare your total annual costs—including deductibles, copays, and likely service needs.
• Read the fine print and ask questions about provider networks and PT coverage.
• If you won’t meet your deductible, explore self-pay discounts—it might save you more than you think.

At New Life Physical Therapy, we believe every patient deserves transparent, high-quality, value-based care—whether you use insurance or pay directly. If you’re reviewing your insurance options and want to understand how your benefits or our self-pay programs work, our team is happy to help.

📞 Call us at 608-742-9356 or visit www.newlifept.com to learn more.