10/23/2026
Let’s talk Medicare (traditional) versus Medicare Advantage! Open enrollment is now and understanding the options allows for a more informed decision.
You may hear friends, family members, coworkers, or healthcare providers say, “NO TO MEDICARE ADVANTAGE,” but they may not explain why. Many healthcare professionals prefer and support Traditional Medicare for good reasons. Rooted Courage agrees with most providers who encourage people to choose Traditional Medicare. However, as a social work agency, we believe it is important to explain both options and how each one may help.
Medicare (Traditional) - Federal Health Program
Pros:
✅Nationwide Freedom: Allows individuals to utilize any doctor, specialist, hospital, etc. in the United States that accepts Medicare. Most often, NO referral necessary.
✅No Prior Authorizations: Services needed by the individual can be accessed without waiting for an insurance company to approve the service.
✅No Network Limits: Traveling does not impede service due to “out of network”.
Cons:
🚫No Out-of-Pocket Cap: There is no limit for out of pocket expense. (This can be remedied with a supplement policy, Medigap, Medicaid, other appropriate coverage). This also can mean higher out of pocket expenses than another plan.
🚫Separate Drug Coverage: Prescription drugs are not included (Part D).
Additional Services: Other services such as vision, dental, hearing aids, and gym memberships are not included.
🚫Premiums: 20% coinsurance after deductible, Part B and Part D are separate costs.
Medicare Advantage - Privately Managed by Insurance Companies
Pros:
✅All-in-One Benefits: Hospital (Part A), Medical (Part B) and Prescription (Part D) are one plan versus separate.
✅Out-of-Pocket Maximums: Yearly limit to out of of pocket costs related to IN NETWORK services.
✅Additional Services: Can include dental, vision, hearing, over the counter allowance, and gym memberships.
✅Lower Monthly Premiums: Very low or potentially even $0 premium (excludes Part B premium in most cases).
Cons:
🚫Restrictive Network: Services must be provided by local HMO or PPO networks. Out of Network is typically not covered or very costly.
🚫Prior Authorization and Referrals: Services the plan considers necessary require prior authorization (procedures, scans, specialists). Often creates delay in service provision or denial of the claim.
🚫No Medigap: Cost-sharing to supplement financial burden is not allowed.
🚫Challenging to Switch: Switching to Traditional Medicare later can create challenges when signing up for Medigap (medical underwriting) and can be more costly or harder to be approved.
Takeaway:
➡Medicare (Traditional) is ideal (espeically when paired with Medigap and Part D) for those who desire freedom of care, travel, are facing chronic illness, and do not want insurance dictating care. Additional benefit is knowing the plan, though maybe higher in premium, will have minimal to $0 out of pocket expense based on the service/stay.
➡Medicare Advantage is ideal for those who desire an all-in-one plan, healthy individuals who minimally need care, budget driven individuals, and those who don’t desire to find supplemental coverage for the extras (dental, vision, etc).
*Rooted Courage is not sponsored or paid by either Medicare option to favor one over the other. Rooted Courage is a private social work agency. We follow social work ethics by sharing information and supporting informed choices. While we prefer Traditional Medicare, each person may choose the coverage that best fits their needs and preferences and can still receive our help.
