Toni Says: What is "Traditional" Medicare?
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 don’t 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,
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/Traditional Medicare consists of only Medicare Parts A (hospital insurance) and B (medical insurance) 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 no network with Original/Traditional Medicare. If your hospital, doctor, or health care provider accepts “Original” Medicare or Medicare assignment, then they will accept “Traditional” Medicare; they’re 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 B. Johnson flew to Independence, Missouri, to sign Medicare into law in front of former President Harry S. Truman, who had originally tried to pass a national health care plan.
Medicare Part A is for an in-patient hospital stay. The Part A deductible for 2026 is $1,736, and there are six deductibles in a year. Yes, that’s right: Part A has a benefit period of 60 days, so every 60 days there is a new deductible. Skilled nursing (medically necessary short-term care after a hospital stay) has a $0 copay for days 1-20, but there is $217 copay 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 copay.
Medicare Part B (medical insurance) has a monthly premium of $202.90, which is based on income. Americans with income levels under $109,000 for an individual or $218,000 for a couple will pay the $202.90. If your income is higher, the premium will be higher. The 2026 Medicare Part B deductible is $283.
—Medicare Part B covers “medically necessary” services and products such as office visits, surgery, hospital stays, outpatient hospital care, tests, durable medical equipment like a walker or oxygen and others.
—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 Medicare covers at $623. It is the $623 that the 20% is applied to.
Sean, you may be wondering how you pay for the out-of-pocket expenses that come with Medicare Parts A and B. Your option would be a Medicare Supplement/Medigap policy, Medicare Plan G. This works only with Original/Traditional Medicare, and does have a monthly premium based on which plan is selected. FYI: A Medicare Advantage Plan Part C (HMO/PPO) plan is not associated with the Original/Traditional Medicare but with private health insurance companies and is not what your doctor’s office has advised you to use.
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.
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Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.
©2026 Toni King. Distributed by Tribune Content Agency, LLC.
Copyright 2026 Toni King, Distributed by Counterpoint Media
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