When you’re approaching age 65, the array of Medicare options available to you can sometimes feel overwhelming. First, should you stay on your employer plan if you’re still working? If you choose to go on Medicare, should you opt for Original Medicare or a Medicare Advantage plan? And from there, what specific plan is right for you?

Let’s take a look at some of the common questions and the pros and cons of each option so that you can make an educated decision based on what’s best for you.

You’re still working. Should you keep your health plan?

You have a seven-month window to enroll in Medicare – the three months before and after your 65th birthday, plus your birthday month. This is called the Initial Enrollment Period, or IEP. Even if you’re still working and receiving benefits from your employer-sponsored health plan, you can enroll in Medicare, but you don’t have to.

There are two major factors at play here. First, how much are you getting for your money on your job’s health plan? If you’re getting top-notch benefits with minimal or no payroll deduction, it might make sense to stay in your current plan. However, if you’re dissatisfied with your plan, either due to cost or access to care, you might do better on Medicare.

The second factor is the size of your company. If you work for a company with more than 20 employees, Medicare would be secondary to your company’s group plan, meaning your private insurance would pay first and Medicare would pay second.

However, if your company has fewer than 20 employees, it almost always makes sense to enroll in Medicare as soon as you turn 65. In this case, Medicare would be the primary payer and your group plan, if you opt to keep it, would be secondary. If your group plan is secondary, you may need to enroll in Medicare Part B before the group plan will pay.

What about late enrollment penalties?

If you work for a company that has at least 20 employees on its group health plan, you will not get hit with late enrollment fees. If you opt to keep your job’s group plan and delay enrolling in Medicare during your Initial Enrollment Period, you can enroll later. This enrollment period is known as a Special Enrollment Period. Typically this window would close eight months after your group health plan or employment ends, whichever happens first. One thing to note, COBRA is not considered group health plan coverage. Getting COBRA will not change when your Special Enrollment Period ends.

Original Medicare vs. Medicare Advantage

According to the Kaiser Family Foundation, an independent source for health policy news, more than half of all eligible Medicare beneficiaries opt for a Medicare Advantage plan. This figure has been rising steadily for the past 15 years. In 2008, 22% of eligible beneficiaries were enrolled in a Medicare Advantage plan, and in 2023 that share reached 51%.

Why are Medicare Advantage plans growing in popularity and are they worth the hype?

Both Original Medicare and Medicare Advantage provide coverage for basic medical treatments and care. Many Medicare Advantage plans will also offer coverage for dental, hearing, vision and even gym memberships. These benefits are not covered under Medicare Part B, but can be included in a Medicare Supplement plan. Many Medicare Advantage plans also have low or no cost premiums.

So what is the catch?

A main drawback to Medicare Advantage is that you’re limited to seeing in-network providers to receive maximum coverage. Original Medicare does not have networks. You can see any doctor in the country who takes Medicare. Also, the low-cost premiums on an Advantage plan often come with higher copays and more restrictions on services, like prior authorizations and pre-approvals for care.

Original Medicare, on the other hand, has no networks. It has no copays, no pre-approvals and no prior authorizations. When coupled with a Medicare supplement policy, it provides predictable healthcare costs. Medicare Advantage plans might be alluring for their low premiums, but you could be paying for that later with high copays and more limits on your ability to access care.

Ultimately you will need to shop around for the best plan for both your financial circumstances and your health care needs.