Making the move from private, employer-provided health insurance to Medicare can be daunting because there are so many plan options on the market today. Seniors just entering the Medicare beneficiary pool often need a clear orientation, and those who are choosing a new plan during open enrollment can also benefit from a refresher on the steps for picking a Medicare plan.
Here, we unpack everything you need to know to pick the best Medicare plan for your needs.
How to Pick a Medicare Plan
Medicare is federal health insurance for those age 65 and over and some younger people with qualifying disabilities.
Medicare was launched in 1965 to meet the health insurance needs of retirees who could no longer access private health insurance from an employer. Since then, it has grown and changed, and today, it provides coverage to more than 68 million Americans through a variety of plans and options.
There are two main types of Medicare coverage:
— Original Medicare consists of Part A and Part B and is administered by the Centers for Medicare & Medicaid Services. Part A covers in-hospital care, while Part B covers outpatient doctor visits.
— Medicare Advantage, sometimes called Medicare Part C, is a type of Medicare plan administered by private health insurance companies. Medicare Advantage plans must be approved by CMS. These plans are required to provide at least the same level of coverage as Part A and Part B, and many also include additional benefits, such as prescription drug coverage, vision, dental and hearing services.
According to data from KFF, an independent health policy research and polling organization, in 2025, approximately 54% of eligible Medicare beneficiaries are enrolled in Medicare Advantage plans. The Congressional Budget Office projects that by 2034, enrollment in Medicare Advantage is expected to grow to 64% of all Medicare beneficiaries.
Medicare Advantage plans are attractive because many offer comprehensive coverage, include value-add benefits such as grocery cards and gym membership reimbursements and typically have low out-of-pocket costs, explains Sam Olmstead, director of producer services, Medicare with Providence St. Joseph Health in Southern California.
Other terms you may come across as you begin diving into Medicare research:
— Medicare Part D. This is the prescription drug component of Medicare that is typically sold alongside original Medicare. Medicare Advantage plans often include this coverage.
— Medigap. Medigap plans are supplemental insurance plans that help pay for out-of-pocket costs that original Medicare doesn’t cover.
— Medicaid. Medicaid is sometimes confused with Medicare, but the two are entirely different programs. Medicaid is the joint federal and state health insurance program for low-income individuals, regardless of age. You must meet strict financial qualifications to access Medicaid.
— Special Needs Plans. SNPs are a type of Medicare Advantage plan tailored for people who are institutionalized, have certain chronic or disabling health conditions or are dual eligible, which means they qualify for both Medicare and Medicaid coverage. In 2026, SNPs are expected to continue growing the fastest of the Medicare Advantage plans available.
With those terms laid out, follow the steps below to help you make the right Medicare coverage choice for your health and budget needs:
1. Check your timing.
2. Consider budget and costs.
3. Look closely at prescription drug coverage.
4. Pick your medicare plan.
5. Enroll in medicare.
[READ Medigap vs. Medicare Advantage: Which Should You Buy?]
Step 1: Check Your Timing
Most people need to enroll in Medicare during the initial enrollment period, which is the seven months surrounding your 65th birthday. That period begins three months before your birthday month and ends three months after you turn 65.
If you don’t sign up within that window and you don’t qualify for a special enrollment period, you may get hit with a late enrollment penalty and potentially experience a lapse in coverage. Special enrollment periods allow people to enroll outside of their 65th birthday window following unplanned events, such as job loss.
What to do if you’re still employed when you turn 65
If you’re still working when you turn 65 and are receiving health insurance through your employer, you don’t need to enroll in Medicare.
Federal law states that an employer group health plan (sponsored by a company with 20 or more employees) can be the primary health care carrier, regardless of age. And if you’re still working but your employer doesn’t offer health insurance, you can apply for Medicare coverage when you turn 65.
If you work for a company that employs fewer than 20 people, you can wait until you stop working to enroll in Medicare Part B.
If you don’t have to pay a premium for Part A, there’s no reason to wait to sign up for it. Your insurance through your employer will pay first, and then Medicare Part A will pick up remaining expenses for eligible hospitalization costs while you are enrolled in both plans.
The same applies regarding your spouse’s company size if you are insured through them. If you or your spouse is employed and insured by a company with fewer than 20 employees, you’ll enter a special enrollment period when you retire or otherwise cease to be covered by the employer. You have eight months after losing your job-based coverage to enroll in Medicare without having to pay a penalty.
[When (and How) to Sign Up for Medicare if You’re Still Working]
What do you if you’re already enrolled in Medicare
For those already enrolled in Medicare, the annual open enrollment period runs from October 15 until December 7 each year.
This fall open enrollment period is a great time for seniors to review their options and make sure they have the best coverage heading into a new year, according to Chris Orestis, a Maine-based senior care advocate and expert in retirement, long-term care and specialty senior living funding solutions. He also serves as president of retirement consultancy Retirement Genius.
“People should never ignore the open enrollment period, and they should put as much effort into understanding their Medicare options and whether it’s time to make a change as they put into shopping for items on Amazon,” he says. “This is one of the most important aspects of an aging person’s life, and they should not take it for granted.”
Any changes you make during the open enrollment period will go into effect on January 1. During open enrollment, you can:
— Switch from original Medicare to a Medicare Advantage plan
— Join, drop or switch to another Medicare Advantage plan (or add or drop prescription drug coverage)
— Join a Medicare prescription drug plan if you are in original Medicare
— Switch from one Medicare prescription drug plan to another if you are enrolled in original Medicare
[Read: When Can You Sign Up for Medicare?]
Medicare changes in 2026
It’s important to review your plan details every year, but particularly heading into 2026, there are some changes to be on the lookout for, says Whitney Stidom, vice president of consumer enablement with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
“With widespread changes for many Medicare plans in 2026, being proactive is key and can help you save time, potentially money and contribute to improved well-being.”
And she adds that shopping around is crucial. “By comparing Medicare Advantage plans based on individual needs and budgets, you can potentially save over $1,800 annually on average in out-of-pocket costs while maintaining access to quality care.”
You don’t have to enroll in a new plan each year, but your plan’s details can change, so it’s a good idea to review what’s changing before simply reenrolling in the same plan during the annual enrollment period. “A significant number of Medicare Advantage and Part D plans are making changes to their cost and benefits for 2026, and some plans are being eliminated entirely,” Stidom says.
As a result, “changing plans or picking a new one is a good idea for people in these scenarios. Plus, personal health needs and financial circumstances change over time, so the right plan for you last year may not be the best option for you this year.”
If your Medicare Advantage plan is going away in 2026 and you don’t select a new one, you’ll still be covered by original Medicare Part A and B, Stidom says. But you may lose prescription and other coverage such as dental, vision and hearing services in 2026 depending on what your previous plan covered.
Step 2: Consider Budget and Costs
While Medicare is designed to support older adults, many of whom are on a fixed income, there are still some associated costs that you need to know about, including premiums, deductibles and copayments.
With original Medicare, costs can include:
— Part A deductible and coinsurance fees, which can vary depending on the service
— Part B premium, which is a monthly payment required for medical coverage
— Part B coinsurance, which is typically 20% of the Medicare-approved amount for services, after you’ve met your deductible
— Part D premium for prescription drug coverage, which is a monthly cost that varies based on your income
With Medicare Advantage, you will have a different range of premiums, deductibles and coinsurance amounts that vary by plan and provider. Some plans charge no premium, while others may charge something similar to what you’d pay for original Medicare — it all depends on the company and plan you select.
Medigap costs
As mentioned, a supplemental Medigap policy can help offset your out-of-pocket costs in original Medicare and can be applied to copayments, deductibles and other out-of-pocket expenses. These policies are available only to people who are enrolled in original Medicare — you cannot buy a Medigap plan if you have a Medicare Advantage plan.
Medigap policies do not help to pay for any costs not covered by original Medicare, such as dental or vision care. There are 10 options on the market, and not all of them are available in every state.
Step 3: Look Closely at Prescription Drug Coverage
Every year, plans change the payment tiers of prescription drugs and the list of pharmacies they work with to offer the most affordable prices. Check your plan’s list of covered medications — called a drug formulary — carefully each year to see what may have changed, especially this year, says Meagan Dow, a senior strategist within the client needs research team at Edward Jones, a financial services firm headquartered in St. Louis, Missouri.
That’s because the passage of the Inflation Reduction Act in 2022 has changed how some medications are priced and has capped out-of-pocket maximums for prescription drug coverage at $2,000, she says. This means that the prescription drug plan you have currently may be changing, and you’ll need to confirm that any medications you know you’ll take in 2026 are still on the covered medications list.
You can use Medicare’s plan comparison tool or U.S. News’ Best Medicare Part D Companies to see which options work best for you.
One common misconception is that Part D plans with the highest premiums will cover the most prescription medications — this isn’t necessarily true. So, check the fine print.
Step 4: Pick Your Medicare Plan
“If you are new to Medicare, your first decision is a simple fork in the road,” says Andrew Shea, executive adviser at Walter Alan & Associates, a boutique consultancy. “Do you want original Medicare or an Advantage plan?”
Of course, the monthly premium is one important factor when choosing a plan. But there is much more to it than that, so consider the following questions:
— What are the out-of-pocket costs, including copays and deductibles?
— Is there coverage for all your preferred physicians, medications and required services?
— How does the plan rate in terms of patient experience, safety of care and other important factors?
You can find out how Medicare Advantage plans, Medicare prescription drug plans and Medigap policies are rated on Medicare.gov, or visit U.S. News Best Medicare Advantage Companies.
Another primary consideration is future possibilities. What if you have a major illness next year — would the plan you are considering still work well for you?
How do I know which Medicare plan is best?
There is no one single best Medicare plan, Stidom says. “Everyone has different medical needs, priorities and finances,” she notes.
With an average of more than 40 Medicare Advantage plans to choose from in your local area, you’ll need to carefully compare plans to see which provides the best coverage for your specific health needs.
Step 5: Enroll in Medicare
So, how do you apply for Medicare? You first need to enroll by taking one of the following actions:
— Going to the Medicare sign-up site
— Calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
— Visiting a local Social Security office
— Calling the Railroad Retirement Board at 1-877-772-5772 (TTY 312-751-4701)
Common Medicare Pitfalls
Navigating the dozens of Medicare plans available in your area can be confusing and time-consuming, and many beneficiaries stumble into a variety of mistakes when trying to navigate the process on their own. Common Medicare mistakes include:
— Becoming complacent. If you’re not reviewing your Medicare plan annually during the annual enrollment period that runs from October 15 through December 7 and comparing plan options, you may be missing out on better coverage or cost savings from another plan, Olmstead says. “As beneficiaries age, so do health care needs.”
— Assuming all plans are the same. Medicare Advantage plans can vary significantly in terms of the prescription drugs they cover and at what out-of-pocket cost, as well as what supplemental benefits are included, such as vision, dental, hearing, gym memberships and more, Stidom explains.
— Choosing a Medicare plan based on nonmedical benefits. While frills such as a grocery card or transportation services can be highly attractive, they sometimes are there to offset a weaker plan. “Those value-add benefits cost money, and as a result, the underlying medical coverage benefits are diminished,” Olmstead explains.
— Focusing on the plan rather than the network. If you’re choosing a plan based on the name of the company offering it, you should do a little more investigation. The medical group and hospitals accessible via that plan are far more important than the company name on the care.
— Missing the enrollment period. Unless you have a disability that qualifies you for coverage earlier, you’ll become eligible to sign up for Medicare three months before your 65th birthday, and that window remains open for three months after your birthday. Don’t delay, as penalties can accrue if you miss the enrollment period.
— Not doing your homework. It’s important to carefully review all the details of the plan and compare it to any other plans you’re considering before signing up. To avoid any unpleasant surprises during the coverage year, be sure to read the fine print and fully understand all the details of the coverage before you sign up.
— Not paying attention to prescription drug coverage. Many Medicare Advantage plans have prescription medication coverage included, but it’s important to check what medications are included, as this coverage can vary from plan to plan.
— Not doing the math. When you’re comparing plans, do the math to figure out what sort of out-of-pocket expenses you’ll be looking at so you know whether your budget will cover those costs.
— Going at it alone. There are many advisors who can help you navigate this complex and confusing world at no cost to you. Contact your local senior center or Area Agency on Aging to get connected with a Medicare advisor who can walk you through the specifics of each plan you’re eligible for.
Who Can Help Me Choose a Medicare Plan?
Help is available, so don’t hesitate to reach out to a professional.
“In every community there are local agents that specialize in Medicare who can answer your questions,” Orestis says.
Some of the top resources you can tap include:
— SHIP. For free personalized counseling services, contact your State Health Insurance Assistance Program, which assists and advises Medicare-eligible individuals and their families or caregivers.
— CMS. The Medicare Rights Center also has a national helpline: 1-800-333-4114.
— Local resources. Community resources — such as senior centers — are potential sources of information and assistance when choosing the health care plan that best suits you.
— A broker or agent. A licensed insurance agent can help you wade through the options.
You should make sure to “work with someone who understands senior insurance really well and can help you weigh the pros and cons,” Shea says. “You don’t want a jack-of-all-trades who sells you home and auto insurance and, oh, by the way, also has medical insurance if you want it.”
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Steps for Picking a Medicare Plan originally appeared on usnews.com
Update 10/29/25: This story was published at an earlier date and has been updated with new information.
