Important Facts About Traditional Medicare and the Medicare Advantage Plan

We’ve always heard of the saying that “Health is wealth” but with everyone exposed to everyday pollutants and harmful elements, sickness is inevitable. As we age we are also more prone to illnesses.  Our level of financial preparedness is always at stake when our health is compromised, but, thank goodness for Medicare, the endless worry of handling medical expenses has become manageable.

There are Medicare options available to everyone and these are basically categorized as traditional Medicare and the Medicare Advantage Plan. Let’s take a look at these categories:

What is Traditional Medicare?

This health insurance program which started in the year 1966 under the Social Security Administration is administered by the US federal government and intended for US citizens ages 65 and older. Persons who are below 65 years old who have disabilities or who suffer from renal disease and sclerosis are also eligible to avail of the program.  Once you reach age 65 you are automatically enrolled in Medicare Part A and Part B.  The following are the coverages for Part A and B:

Part A – It covers hospital care, home health care, skilled nursing facility care and hospice care.  It is free and you do not have to pay premiums if you have been a regular contributor to Social Security for at least 10 years.

Part B – It covers medical insurance which include doctor visits, laboratory tests and x-rays, outpatient procedures, use of medical equipment and ambulance services.

What is Medicare Advantage Plan?

The Medicare Advantage Plan is also called Part C and this is administered by private insurers. It is administered and managed by private entities but regulated by the federal government and combines Parts A and B. Here are some of the recognized best private insurance companies in the states of Florida, Texas and New York that offer highly rated Medicare Advantage Plans:

  • Alignment Health Plan
  • Optimum Healthcare Inc.
  • United Healthcare
  • Independent Health
  • Kelseycare Advantage

Part D or Prescription Drug Plan

It is an optional plan that is administered and managed by private insurance companies which have links or contracts with the federal government.  It covers outpatient prescription for drugs, is availed separately and also known as the Prescription Drug Plan. If you availed of the Medicare Advantage Plan which also includes drug coverage then that plan is called the Medicare Advantage Prescription Drug Plan.  It is designed to supplement traditional Medicare or Part A and B and covers commonly used prescription drugs.

Medigap or Medicare Supplemental Insurance

These are private health insurance plans that pay for coverage gaps not included in traditional Medicare. They are only used along with traditional Medicare Part A and B which means that it is not applicable for use with a Medicare Advantage plan.

Here are some comparisons between traditional Medicare and the Medicare Advantage Plan to help you determine the best health insurance options for you and your family.

Traditional Medicare (Part A & B)

Enrolment / How to Enroll: You are automatically qualified for Part A if you have completed at least 40 calendar quarters (10 years) of payment to Social Security and should notify them of your enrolment. You may however opt to avail of the private Medicare Advantage plan.  You can enroll online via or by calling Social Security at 1-800-772-1213 during weekdays from 7 AM to 7 PM. You may also enroll in person by visiting the Social Security office.

Costs: Part A is free if you have completed payment of Social Security taxes for at least 10 years or 40 calendar quarters.  For Part B, you have to pay a monthly premium and you may need to also pay coinsurance, copays and deductibles. There is a cap or out-of-pocket maximum on the amount that you can spend for your health care.

Service Accessibility: You are entitled to choose your own doctor or hospital since with traditional Medicare there is no prior authorization and referrals needed.

Medicare Advantage Plan (Part C):

Enrollment/ How to Enroll: You must issue an authorization indicating that you want to opt in under the Medicare Advantage Plan and should be enrolled in Part A and B for you to be eligible for this plan.  It also means that you regain the right and protection of the traditional Medicare coverage but that you choose for the provision of said benefits through a private plan.

Costs: You must pay a monthly premium which is the same amount as the premium paid for Part B.  However, the costs may generally vary depending on the type of plan that you choose. Just some of the additional out of pocket costs may include yearly deductible, extra monthly premiums and use of network providers, among others.  Cost-sharing charges may apply but Medicare advantage plans cannot charge cost-sharing fees for renal dialysis services,

Service Accessibility: You have to obtain authorization for specific services and there is a specific network of health providers that you can choose from.  There is also a specific list of service areas from which you can avail the medical advantage plan.


These are the 2 major Medicare coverage options ideally available for you to enjoy optimum health insurance advantages:

Option 1: Traditional Medicare (Parts A and B) + Part D or Prescription Drug Plan + Medigap or Medicare Supplemental Insurance

Option 2: Traditional Medicare + Medicare Advantage Plan + Part D or Prescription Drug Plan

It’s been said time and again that a healthy life is a happy life so we should take good care of ourselves now and not wait for another day, week or month since we never know when sickness will strike us and our loved ones. Preparedness is key and one vital step you can do is ensuring that you have the right health insurance coverage plan.   Being prepared is tantamount to being responsible and by having a Medicare or Medicare Advantage Plan you and your family are assured that you are in good hands.