Understanding Medicare Plans and Options

By Joseph Kmetz

Joseph Kmetz

Medicare is the national insurance program for adults age 65 and older. It’s a benefit most working adults pay for throughout their lifetime. If you are enrolled or eligible for it, the number of different plans and options can be overwhelming.

Understand your options, so you can pick the best plan for you or your loved one.

How Do I Enroll for Medicare?

You are automatically signed up for Medicare at age 65. However, if you want to select a Medicare health or drug plan, you have a seven-month period around your 65th birthday to sign up for one. This is called the initial enrollment period, and it:

  • Starts three months before you turn 65; if a plan is selected during this period, it will go into effect the first day of the month you turn 65.

  • Includes the month you turn 65; if a plan is selected during this period, it will go into effect the first day of the month following your 65th birthday.

  • Ends three months after you turn 65; if a plan is selected during this period, it will go into effect the first day of the month after you enroll.

If you later decide to change your plan or join a plan after that seven-month period has closed, enrollment is open each year from Oct.15 to Dec. 7. Changes or enrollment during this time period will go into effect the following January.

What are My Options?

In general, there are two types of Medicare plans: Traditional Medicare and Medicare Advantage.

Traditional Medicare

Traditional Medicare includes Parts A and B. Part A is automatic and includes hospital insurance, which covers hospital stays, as well as skilled nursing facilities and hospice. Part B is optional and is deducted from your Social Security should you enroll. It includes medical insurance, which covers outpatient services, as well as some physician visits and preventative care. Other supplemental plans can be added through private insurance companies; these are paid for out-of-pocket.

Medicare Advantage

Also referred to as Medicare Part C or MA plans, Medicare Advantage is an all-inclusive plan that includes both parts A and B, as well other coverage such as prescription drugs, dental and more, depending on the plan. These plans are offered through private Medicare-approved companies. If you join a Medicare Advantage plan, you will likely be required to choose healthcare providers that participate in your plan’s network.

What to Consider When Picking a Medicare Plan

When it comes to deciding between a traditional Medicare plan and a Medicare Advantage plan, consider two things: your income and your freedom to choose your provider. As you add supplemental plans to traditional Medicare, it can cost more than Medicare Advantage plans. However, with traditional plans, you have the freedom to choose any Medicare-approved, certified provider anywhere. Most Medicare Advantage plans require you to see a provider within their network and may require prior approval or a referral for certain procedures or healthcare services.


Joseph Kmetz is Director of Case Management, Encompass Health.