Issue #50: June 2026

Most people don’t think much about Medicare until something unexpected happens. That’s when understanding your coverage becomes important.

After you sign up for Medicare, you probably don’t think a lot about it again. Right?

That’s pretty normal.

If you see your primary care doctor regularly, have no new health issues, and the medicines you take are covered by your Medicare coverage, you probably don’t see much reason to pay attention to the details of your plan. However, situations can change.

Consider these two examples that show how things can change quickly.

Scenario 1: You’re out enjoying a hike at one of your favorite places. Unfortunately, you take a nasty tumble that causes a rather big injury. So big, in fact, that you need surgery! This was a very unexpected event in your life, and to take matters further, before you’re as good as new, you have to work with physical therapy.

Scenario 2: You have been diligent with your routine health screenings since you know you should get them. However, you receive scary news that some of your test results were abnormal. This means more testing and lots of patience. It could be nothing, but to be safe, you take the proper steps to check further. Regrettably, your doctor finds that there is something wrong, and you need further treatment.

It’s at these times that people start paying much closer attention to their Medicare coverage.

There are important differences between Original Medicare and Medicare Advantage.

Medicare Advantage plans are another way to receive Medicare-covered benefits through private insurance companies approved by Medicare.

Even though both provide Medicare coverage, they can work differently in everyday situations.

A Few Important Differences

^*Beneficiary and Family Centered Care Quality Improvement Organizations
Original Medicare	Medicare Advantage Plans
Usually accepted anywhere in the United States that takes Medicare.	May require use of local provider networks. In other words, you may not be able to see who you want to see.
Coverage rules are generally more standardized.	Plans may have different rules for services and approvals.
Prescription drug coverage is usually purchased separately (Medicare Part D).	Prescription drug coverage is often included.
Certain appeals are reviewed by BFCC-QIOs^*.	Appeals often begin through the private insurance plan.

One difference people sometimes notice quickly involves provider networks and plan rules.

With Original Medicare, people can usually see any provider that accepts Medicare.

With Medicare Advantage plans, you may need to use providers within the plan’s network. Coverage for some services, treatments, or rehabilitation stays may also depend on the plan’s rules and approval processes. Many Medicare Advantage plans also bundle services together, including prescription drug coverage and sometimes extra benefits like dental, vision, or hearing coverage.

In Medicare, the word “provider” is often used to describe healthcare professionals and organizations that provide medical care or services. These can include doctors, hospitals, skilled nursing facilities, home health agencies, therapists, and other healthcare providers involved in a patient’s care.

That may not seem important when you’re healthy, but when your healthcare needs become more complex, these differences can become much more noticeable and meaningful for you.

Appeals can also work differently.

Under Original Medicare, certain appeals related to Medicare-covered services ending or being discharged from a hospital are reviewed by organizations called BFCC-QIOs. These organizations, such as Acentra Health, work with Medicare to help ensure you receive fair and timely review decisions.

Medicare Advantage plans also have appeal rights, but the process may first go through the private insurance company managing the plan.

Travel can also become an important consideration.

With Original Medicare, you can usually receive care anywhere in the country from providers who accept Medicare. However, when you have a Medicare Advantage plan, the coverage may depend on the plan’s network and service area. While this may not be a current priority, when you travel, it can become an issue.

Maybe you are spending part of the year in another state at your second residence or taking an extended vacation to visit friends or family out of state. What happens if you need medical care while away from home? Will medical services be covered?

It is important to note that none of these facts mean that one type of Medicare coverage is automatically better than another. Instead, it simply highlights that understanding the type of coverage you have should be a priority before something happens.

Healthcare needs can change over time, and the Medicare plan that felt right years ago when you signed up may feel different later if care becomes more complicated.

Medicare Open Enrollment happens each fall and will give you a chance to review your coverage, including any drug plans you may have. Even though you may not be able to make changes to your Medicare coverage right now, consider keeping this information to review later this year, during Medicare Open Enrollment.

To learn more about Medicare coverage options, visit Medicare.gov or speak with a trusted Medicare counselor.

Would you recognize Medicare fraud if it showed up on your statement? Simple tools can help you spot warning signs early.

Does it seem like you are hearing more about Medicare fraud in the news? Thinking about someone else having your Medicare information can be scary.

So, let’s look at a couple of free resources from Senior Medicare Patrol (also called SMP) that can help you keep your Medicare information safe.

Keeping track of doctor visits, medical equipment, prescriptions, and healthcare services can protect you from Medicare fraud and billing mistakes. The SMP offers free My Health Care Trackers to organize your healthcare appointments, services, and supplies you receive throughout the year. They allow you to compare your records to your Medicare statements, so you can spot possible errors or suspicious charges.

Using a tracker may help reduce billing errors, detect possible medical identity theft, and make it easier to report suspected Medicare fraud or abuse.

Fun fact: There is more than one delivery option! You can choose to get a paper tracker booklet if you prefer, or you can get the app for your mobile device.

To learn more about the free My Health Care Trackers or to request one be mailed to you, visit https://smpresource.org/you-can-help/my-health-care-tracker/.

If you’ve already decided that you would rather learn more about the app, including how it can help you stay organized, spot possible Medicare fraud, report concerns, and receive scam alerts, visit https://smpresource.org/app/.

In this issue

Don't Keep This a Secret

Original Medicare or Medicare Advantage? Why Does It Matter?

Medicare Fraud: Track Your Care, Protect Your Medicare

Issue #50: June 2026

In this issue

Don't Keep This a Secret

Original Medicare or Medicare Advantage? Why Does It Matter?

More Information

Medicare Fraud: Track Your Care, Protect Your Medicare

When Should You Call Acentra Health?

June is Men's Health Month

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