Over the years, we’ve covered the distinctions between federally managed Original Medicare (Parts A, B, and D) and privately managed Medicare Advantage (Part C) plans. Refresh your knowledge here.

What Are Your Fellow Americans Over Age 65 Choosing?

As of 2025, 54 percent of those eligible were enrolled in Medicare Advantage (MA) vs. just 33 percent a decade ago. The rate of increase, however, has started to decline over the past couple of years.

Who Is Opting for Medicare Advantage?

Almost 25 percent of all MA program participants are in Special Needs Plans (SNPs), and SNPs account for a whopping 85 percent of Medicare Advantage increases since last year. This is likely a result of reduced cost-sharing and additional benefits offered, especially for enrollees who also qualify for Medicaid. See below for further details on SNPs.

What Drives Original Medicare Enrollment?

Provider choice is cited as the biggest benefit of Original Medicare. While Medicare Advantage may offer lower premiums and extra coverage areas, its provider network is significantly narrower and its plans require more prior authorizations.

Determining the right Medicare options for you is an important and complex process. We’ve weighed the costs and benefits and can help align the best plans with your healthcare needs, financial outlook and lifestyle. Contact us to set up a complimentary consultation at your convenience.

Resources: kff.org; medpac.gov

Approaching age 65 is an important milestone — in your life and in healthcare coverage. If, like millions of older Americans, you, your spouse, or both are still working and enrolled in an employer (group) medical insurance plan, there are critical decisions to weigh now to avoid financial penalties or gaps in coverage later.

Part A

Many people enroll in Medicare Part A (hospital insurance) at 65 because it’s usually premium-free. However, if you’re contributing to a Health Savings Account (HSA), enrolling in any part of Medicare means you can no longer contribute to your HSA. That’s an important planning detail to review.

Part B

If you’re covered by an employer plan (yours or your spouse’s), you may be able to delay Medicare Part B without penalty if the employer has 20 or more employees. However, if you do enroll and stay on the employer plan, the employer plan usually pays first, and Medicare would pay second. If the employer has fewer than 20 employees, Medicare generally becomes primary at age 65, and delaying Part B enrollment could lead to coverage gaps or penalties.

When You Retire

If one spouse over age 65 retires and loses employer coverage, that spouse may qualify for an 8-month Special Enrollment Period (SEP) to sign up for Medicare Part A or B without penalty. The SEP starts the month after employment ends or employer coverage ceases, whichever comes first. There is also a 2-month (63-day) window to join Part D or Medicare Advantage drug plan. Critical factors:

• You must enroll during this time to avoid steep penalties
• COBRA and Retiree Coverage do not count as current coverage. The SEP clock starts counting down when you stop working or regular employee coverage ceases.

How an Expert Can Help

While working and planning your transition to retirement, there are numerous complex questions to consider:

• How much does the employer plan cost compared to Medicare?
• Are your doctors and prescriptions covered the same way?
• Do you travel often or live in more than one state?
• Are you coordinating coverage for a spouse?
• What is your projected financial situation and healthcare usage over the coming years?

Everyone’s needs and goals are a little different. Addressing these questions now can make the transition smooth and stress-free. Let us guide you into the next phase with a strong plan for Medicare enrollment.