Doctor’s Advice…Enroll in Traditional Medicare…What is that?

Good morning, Toni:         

I have been reading your Medicare column, and now I need your Medicare help.  I am retiring when I turn 65 in April.  I was hospitalized in November of 2025 with a triple bypass surgery. Last week I talked with the office manager at my cardiologist’s office about enrolling in Medicare and what I should do.  She said for me to enroll in “Traditional” Medicare. 

I have no idea what “Traditional” Medicare is? Could you please explain what this is and make it easy to understand?  I do not want to enroll in the wrong Medicare plan and have any issues having my medical bills paid.  Thank you, Toni. 

Sean from  Chattanooga, Tenn.

Hello Sean:

Don’t worry, Sean, I will make this easy for you. Let’s examine just what “Traditional” Medicare is.

Most health care professionals and office personnel call Medicare, “Traditional” Medicare, but Medicare refers to the federal health program as “Original” Medicare. You will not find “Traditional” Medicare anywhere in the medicare.gov website or in the Medicare & You handbook.

Original or Traditional Medicare consists of only Medicare Parts A (Hospital Insurance) and B (Medicare) and not the rest of the alphabet soup such as Parts C or D. Original/Traditional Medicare is also known as your Medicare card. 

There is not a network with “Original/Traditional” Medicare, and this is hard for those who have retired with employer group health insurance to understand, “NO Network”! If your hospital, doctor, or health care provider accepts “Original” Medicare or Medicare assignment, then they will accept “Traditional” Medicare because “Original/Traditional Medicare are the exact same program.

So Sean, you want to know about Original or Traditional Medicare. Let’s first discuss Medicare Parts A and B: Medicare began July 30, 1965, when President Lyndon Johnson flew to Independence Missouri to sign Medicare into law in front of President Harry Truman who had originally tried to pass Medicare as a federal program for America.

MEDICARE PART A (Hospital Insurance) is for an in-patient hospital stay. Part A deductible for 2026 is $1,736 and has 6 deductibles in a year.  Yes, Part A has a benefit period of 60 days, so every 60 days there is a new deductible.  Skilled nursing has a $0 co pay for days 1-20, but there is $217 co pay per day from days 21 through 100.  After day 100 in a skilled nursing facility, you pay the full cost. Medicare Part A also includes hospice and home health care with a $0 co pay.

MEDICARE PART B (Medical Insurance) has a premium of $202.90 which is based on income. The more you make the more you pay. Americans with income levels under $109,000 for an individual or $218,000 for a couple will pay the $202.90.  The more you make, the higher your premium will be. The 2026 Medicare Part B deductible is a yearly one-time deductible payment of $283. 

• Medicare Part B covers “medically necessary” services such as office visits, surgery, hospital stays, outpatient hospital care/services, tests, durable medical equipment, and other medical services. 
• Medicare pays 80% of the Medicare approved amount and you pay 20% of the Medicare approved amount.  For example, a medical provider may charge $1,000 for a service, but Medicare may approve $623. It is the $623.00 that the 20% is applied to.

Sean, you may be wondering how you pay for the out-of-pocket that Medicare Parts A and B have.  Your option would be a Medicare Supplement/ Medigap policy that works only with Original/Traditional Medicare and does have a monthly premium based on which Medicare Supplement plan is selected. FYI:  A Medicare Advantage Plan Part C (HMO/PPO)plan is not associated with Original/Traditional Medicare but with private health insurance companies and is not what your doctor’s office has advised you to use.

For answers to your Medicare and Social Security questions, call the Toni Says Medicare team at 832-519-8664 or email info@tonisays.com. Toni’s new course, a downloadable video series called the “Confused about Medicare Workshop” and the “Medicare Survival Guide Advanced” edition are available at www.tonisays.com. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.