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Date: June 10,2026
Medicare Advantage: How is it Different from Traditional Medicare
As more Medicare beneficiaries choose to switch their medical coverage from traditional Medicare to Medicare Advantage plans (31% in 2015), I receive more and more questions regarding do the outpatient therapy rules and regulations that apply to traditional Medicare also apply to the Medicare Advantage plans. In this article, I will answer the following questions:
- Do Medicare Advantage plans have an annual therapy cap?
- Do Medicare Advantage plans provide the same coverage as traditional Medicare?
- Must Medicare Advantage plans follow National Coverage Decision and Local Coverage Decision policies?
- If a service in not covered by the Medicare Advantage plan, must I issue an Advance Beneficiary Notice of Noncoverage (ABN)?
- For Medicare Advantage plans, must a physician sign and date (ie. certify) my therapy plan of care?
- Do Medicare Advantage plans require functional limitation reporting?
- If I am not a provider with a Medicare Advantage plan, can I see the patient and collect cash for therapy services that would be covered by the Medicare Advantage plan?
- Do Medicare Advantage plans use the National Correct Coding Initiative Edits and modifier 59?
Lets begin!
Do Medicare Advantage plans have an annual therapy cap?
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Attended Ascend in AZ – awesome! You mentioned at the conference about Advantage plans not utilizing the 8-min rule. I am researching this by individual plan(s) as recommended but it would also be by state as well, correct?
Whether or not a Medicare Advantage (MA) plan follows the Medicare “8-minute rule” is MA specific per your contract with them. Your contract may differ from another practices contract in the same or different state.