Medicare Basics

  • At 65, you must choose between Traditional Medicare and Medicare Advantage.
  • Traditional Medicare + Medigap offers broad provider access, fewer denials, and predictable costs.
  • Medicare Advantage bundles coverage but comes with prior authorizations, narrower networks, and potential hidden costs.

Key Considerations

  • Traditional Medicare = flexibility, reliable coverage, good for frequent travelers and dual-eligible (Medicare + Medicaid) beneficiaries.
  • Medicare Advantage = lower monthly premiums and “bonus” benefits, but higher risks of care denials, out-of-network costs, smaller provider networks, and annual plan changes.

Enrollment & Timing

  • Once you turn 65, you can choose between Traditional Medicare + Medigap or Medicare Advantage. During open enrollment each year, you can choose to switch from one plan to another. However, it is important to keep in mind that it is much simpler to move from Traditional Medicare + Medigap to Medicare Advantage than the other way around. Medigap is easiest to buy when you are first eligible, but be aware that premiums can rise, and underwriting may apply if you delay.
  • Initial enrollment period is a 7-month window around your 65th birthday.
  • Annual Enrollment: October 15 – December 7.
  • Medicare Advantage Open Enrollment: January 1 – March 31.

 

Bottom Line

Traditional Medicare + Medigap is best if you…

  • Want more predictable healthcare costs.
  • Prefer the freedom to get care from the doctors and hospitals you want.
  • Prefer to pay more in monthly premiums in order to avoid commercial health insurance red tape that can cause care delays and denials.

Medicare Advantage is best if you…

  • Want to save on monthly premiums and are prepared to pay more out-of-pocket if serious health issues arise.
  • Prefer to have all of your healthcare coverage bundled into one plan and want “bonus” benefits like a gym membership or wellness program.
  • Are comfortable with limited provider networks and the need for prior approvals and referrals for most services.

Risks & Data Points

  • 99% of Tennessee doctors accept Medicare; fewer than half accept any Medicare Advantage plan.
  • Prior authorization delays are widespread (93% of physicians report delays).
  • Medicare Advantage denials increased 55.7% in 2022–23.

Practical Guidance