Frequently
Asked Questions
What’s the difference between Traditional Medicare and Medicare Advantage?
Traditional Medicare is run by the federal government and includes Part A (hospital insurance) and Part B (medical insurance). You can see any doctor or hospital in the U.S. that accepts Medicare, and you can add a separate Part D plan for prescriptions and a Medigap plan to help cover out-of-pocket costs.
Medicare Advantage (Part C) is offered by private insurance companies approved by Medicare. These plans bundle Part A and B—and often Part D—plus may include extra benefits like dental, vision, and hearing. However, they typically have limited provider networks, may require prior authorization for certain services, and can deny payment for care already received.
When am I eligible to enroll in Medicare?
You’re eligible for Medicare at age 65, or earlier if you have a qualifying disability, ALS, or end-stage renal disease. Your Initial Enrollment Period (IEP) begins three months before the month you turn 65 and ends three months after, giving you a total of seven months to enroll without penalty.
Do I need to sign up for Medicare if I’m still working at 65?
If you or your spouse are still working and have credible health coverage through a large employer (typically 20+ employees), you can delay enrolling in Medicare Part B without penalty. However, you should always check with your employer’s HR department to be sure, and consider signing up for Part A if it’s premium-free.
What does Traditional Medicare cover—and what doesn’t it cover?
Medicare covers many essential medical services:
- Part A covers hospital stays, skilled nursing facilities, hospice, and some home healthcare.
- Part B covers doctor visits, outpatient care, lab tests, preventive services, and durable medical equipment.
- Part D covers prescription drugs (sold separately)
However, Medicare does not cover:
- Most dental, vision, or hearing services
- Long-term care (custodial care in a nursing home)
- Over-the-counter medications
To fill these gaps, many people add a Medigap plan. You are guaranteed eligibility for a Medigap plan and the lowest Medigap premium during your initial enrollment period. If you choose a Medicare Advantage plan during your initial enrollment period and then switch to Traditional Medicare later, you may be denied coverage or have to pay a much higher premium.
What is Medigap and do I need it?
Medigap (also called Medicare Supplement Insurance) is private insurance you can buy to help pay for costs not covered by Traditional Medicare, like deductibles, copays, and coinsurance. There are several standardized Medigap plans to choose from.
If you choose Traditional Medicare, having a Medigap policy can greatly reduce your out-of-pocket costs. However, if you wait too long to enroll in Medigap (outside your one-time six-month Medigap Open Enrollment Period), insurers may deny you coverage or charge more based on your health history.
How much will I pay for Medicare?
Traditional Medicare:
- Part A (hospital coverage): Free for most people who worked at least 10 years.
- Part B (doctors’ office coverage): Standard premium is around $185/month, but higher if your income is above a certain amount.
- Part D* (drug coverage): Varies by plan – Average cost in TN is $40 – $50/month
- MediGap* (supplemental coverage): Helps you pay for your out-of-pocket costs like co-pays, deductibles, and co-insurance. Costs vary depending on the plan. Varies by plan – Average cost in TN is $120 – $390/month
*Part D and MediGap are optional but highly recommended unless you have other coverage like Medicaid or VA coverage.
Medicare Advantage:
- Your hospital, doctor, and drug coverage is bundled into one commercial health insurance plan. You pay:
- Your Part B premium: $185/month
- Your Medicare Advantage premium: Average in TN is $20/month and varies by how comprehensive the plan is and what additional benefits are covered.
- Keep in mind: Medicare Advantage plans appear to offer similar coverage to that provided by Traditional Medicare in a simpler package and at a lower cost. However, simplicity and lower monthly premiums typically come with tradeoffs:
- Higher overall costs due to care denials and hidden costs
- Tedious prior authorization processes
- Need for specialist referrals
- Limited provider networks
Can I have both Medigap and Medicare Advantage?
No. You cannot have a Medigap plan (supplemental coverage) and a Medicare Advantage at the same time. BUT you must have Medicare A,B to purchase a Medicare Advantage plan.
Can I switch between Medicare Advantage and Traditional Medicare later?
Do I need a separate prescription drug plan?
If you choose Traditional Medicare, yes—you’ll need to sign up for a standalone Part D prescription drug plan. If you don’t, you could face a late enrollment penalty later on.
If you choose a Medicare Advantage plan, most include Part D drug coverage, but you should still compare plans to make sure your prescriptions are covered and affordable.
What are the hidden costs with a Medicare Advantage plan?
While monthly premiums are usually lower with a Medicare Advantage plan, there could be high unexpected costs down the road including:
- Out-of-Network Charges
- If you see a doctor or go to a hospital outside your plan’s network (except in emergencies), you may pay much more—or even the full cost—for care.
- Prior Authorization Delays or Denials
- Prior authorizations can lead to delays in care or denied coverage, shifting unexpected costs back to you.
- Higher Out-of-Pocket Costs for Complex Care
- Medicare Advantage plans often have copays and coinsurance for each service which can add up quickly if you have an illness, injury, or chronic condition.
- Missed Medigap Opportunity
- If you later switch from Medicare Advantage to Traditional Medicare, you may not be able to buy a Medigap plan—or it could cost more—due to medical underwriting.
- Limited Access to Specialized Care
- Some top specialists, hospitals, or academic medical centers may not accept any Medicare Advantage plans, meaning you’d pay full price for out-of-network care or be forced to switch doctors.
- Annual Changes to Coverage
- Benefits, provider networks, and out-of-pocket costs can change every year, requiring you to carefully review your plan annually to avoid surprises.