Medicare & Medicare Advantage Information

When you first sign up for Medicare — and during open enrollment periods — you can choose how to receive your coverage. There are two main paths:

Traditional Medicare

• Includes Part A and Part B
• You can add a separate Medicare drug plan (Part D)
• You can use any doctor or hospital that accepts Medicare, anywhere in the U.S.
• You may purchase supplemental coverage (Medigap) to help with out-of-pocket costs

Medicare Advantage (Part C)

• Offered by Medicare-approved private companies
• Combines Part A, Part B, and usually Part D
• Often requires using doctors within the plan’s network
• May have different out-of-pocket costs and premiums
• May include extra benefits not offered by Traditional Medicare

Understanding the differences between Traditional Medicare and Medicare Advantage can help you choose the coverage that best fits your needs.

Medicare is divided into several parts, each offering different types of coverage. Here's a breakdown to help you understand your options:

Part A: Hospital Insurance

Part A helps cover:

• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care

Part B: Medical Insurance

Part B helps cover:

• Services from doctors and other health care providers
• Outpatient care (emergency room, imaging, lab and observation services)
• Home health care
• Durable medical equipment (such as wheelchairs, walkers, and hospital beds)
• Many preventive services (including screenings, vaccines, and annual wellness visits)

Part D: Drug Coverage

Part D helps cover the cost of prescription drugs, including many recommended vaccines. You can get Part D by:

• Joining a Medicare drug plan in addition to Traditional Medicare
• Enrolling in a Medicare Advantage plan that includes drug coverage

These plans are offered by private insurance companies that follow Medicare rules.

Medicare Supplemental Insurance (Medigap)

Medigap is extra insurance you can buy from a private company to help pay your share of costs in Traditional Medicare. Plans are standardized and named by letters (like Plan G or Plan K). The benefits in each lettered plan are the same, no matter which company sells it.

Doctor & Hospital Choice

Traditional Medicare

• You can go to any doctor or hospital that accepts Medicare, anywhere in the U.S.
• In most cases, you don’t need a referral to see a specialist.

 Medicare Advantage

• You may be limited to doctors and providers within the plan’s network and service area (for non-emergency care).
• You may need a referral to see a specialist.

Cost

Traditional Medicare

• For Part B-covered services, you usually pay 20% of the Medicare-approved amount after meeting your deductible (this is called coinsurance).
• You pay the monthly Part B premium.
• If you join a Medicare drug plan, you’ll pay a separate premium for Part D.
• There’s no yearly limit on out-of-pocket costs unless you have supplemental coverage (like Medigap, Medicaid, or employer/retiree coverage).
• You can choose to buy Medigap to help cover costs Medicare doesn’t pay. 

Medicare Advantage 

• Out-of-pocket costs vary by plan.
• You pay the monthly Part B premium and may also pay a plan premium. Some plans have a $0 premium and may help cover your Part B premium.
• Most plans include Medicare drug coverage (Part D).
• Plans have a yearly limit on out-of-pocket costs for Part A and Part B services. Once you reach the limit, you pay nothing for covered services for the rest of the year.
• You can’t buy Medigap to cover out-of-pocket costs. 

Coverage

Traditional Medicare 

• Covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities.
• Doesn’t cover routine physical exams, eye exams, or most dental care.
• You usually don’t need prior authorization for services or supplies.
• You can join a separate Medicare drug plan (Part D). 

Medicare Advantage 

• Must cover all medically necessary services that Traditional Medicare covers.
• Plans may use their own criteria to determine medical necessity.
• May offer extra benefits not covered by Traditional Medicare.
• You may need prior authorization for certain services or supplies.
• Most plans include Medicare drug coverage (Part D). You typically can’t join a separate drug plan.