Medicare Education
Understanding Medicare
Medicare has a lot of parts and a lot of choices. We'll look at your situation — your doctors, your medications, your budget — and help you figure out what actually makes sense.
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AEP (Annual Enrollment Period)·Medicare Advantage & Part D·Upcoming Oct 15 – Dec 7
The Parts of Medicare
Medicare is divided into distinct parts, each covering a different aspect of your healthcare. Here is what each one does.
Part A
Hospital Insurance
Covers hospital stays, skilled nursing, hospice, and some home health care. Most people don't pay a premium for Part A if they worked and paid Medicare taxes for 10+ years.
Learn morePart B
Medical Insurance
Covers doctor visits, outpatient care, preventive services, and medical equipment. You pay a monthly premium that's based on your income.
Learn morePart C
Medicare Advantage
Private plans that combine Parts A, B, and usually D into one card. Many include dental, vision, and hearing — often with a $0 premium.
Learn morePart D
Prescription Drug Coverage
Helps pay for your prescriptions. You can get it as a standalone plan or it's usually included in Medicare Advantage. Each plan covers different drugs, so check yours.
Learn moreMedigap
Medicare Supplement
Extra coverage that helps pay what Original Medicare doesn't — like copays, coinsurance, and deductibles. Sold by private insurers with standardized plan letters (A through N).
Learn moreSNP
Special Needs Plan
A type of Medicare Advantage plan designed for people with specific chronic conditions (like diabetes or heart disease), dual Medicare-Medicaid eligibility, or who live in certain care facilities.
Learn moreCMS Star Ratings
CMS rates every Medicare Advantage and Part D plan on a 1–5 star scale each year, based on quality of care, customer service, member experience, and chronic condition management.
We recommend 4-star plans and above. Higher-rated plans tend to have lower member complaints and better care outcomes. Verify any plan's rating at medicare.gov/plan-compare
Medicare Enrollment Periods
Timing matters with Medicare. Missing an enrollment window can lead to penalties and gaps in coverage.
Initial Enrollment Period (IEP)
7-month window around your 65th birthday
Starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. The best time to enroll for full coverage without penalties.
Open Enrollment Period (OEP)
January 1 – March 31
Medicare Advantage enrollees can switch to a different Advantage plan or return to Original Medicare and add a Part D plan.
Annual Enrollment Period (AEP)
October 15 – December 7
The main period each year to change your Medicare coverage, including switching between Original Medicare and Medicare Advantage or changing Part D plans.
Original Medicare vs. Medicare Advantage
Both paths provide Medicare coverage, but they work differently. Compare the key differences to see which approach fits your needs.
What you get
Original Medicare
Part A + Part B
Must add Part D separately. Optional Medigap for gaps.
Medicare Advantage
All-in-one plan
Bundles Part A, B, and usually D in a single policy.
Who provides it
Original Medicare
Federal government
Medicare Advantage
Private insurer
NJ-specific plans — options vary by county.
Monthly cost
Original Medicare
Part B (~$185–200+) + Medigap ($100–250+) + Part D ($10–50+)
Higher monthly, but predictable out-of-pocket costs.
Medicare Advantage
Part B premium required. Plan premium often $0.
Lower upfront cost, but costs vary at point of service.
How you pay for care
Original Medicare
20% coinsurance for most services
Medicare Advantage
Fixed copays per visit (e.g., $20–$50)
Out-of-pocket risk
Original Medicare
No annual maximum — costs can be unlimited without Medigap
With Medigap, exposure becomes very low.
Medicare Advantage
Annual out-of-pocket maximum required by law (~$5k–$9k)
Once you hit the max, the plan covers 100%.
Doctors & hospitals
Original Medicare
Any provider that accepts Medicare — nationwide
Medicare Advantage
Network-based (HMO or PPO)
Must use in-network providers except in emergencies.
Referrals needed
Original Medicare
No referral required
Medicare Advantage
HMO plans require referrals. PPO plans usually do not.
Prior authorization
Original Medicare
Rarely required
Medicare Advantage
Common for tests, procedures, and specialist visits
Prescription drugs
Original Medicare
Must enroll in a separate Part D plan
Medicare Advantage
Usually included in the plan
Extra benefits
Original Medicare
None included — purchased separately
Medicare Advantage
Often includes dental, vision, hearing, and fitness benefits
Varies by plan and carrier.
Travel coverage
Original Medicare
Works with any Medicare-accepting provider nationwide
Medicare Advantage
Mostly local network
Emergency care covered outside service area, routine care is not.
Plan stability
Original Medicare
Very stable from year to year
Medicare Advantage
Plans can change network, benefits, and costs each January
Annual review recommended before AEP.
Am I Eligible?
Most people become eligible for Medicare at age 65, but there are other qualifying circumstances as well.
Age 65 or Older
U.S. citizens and permanent legal residents who have lived in the U.S. for at least 5 continuous years are eligible at age 65.
Under 65 with Disabilities
If you have received Social Security Disability Insurance (SSDI) for 24 months, you automatically qualify for Medicare Parts A and B.
End-Stage Renal Disease (ESRD)
Individuals with permanent kidney failure requiring dialysis or a kidney transplant may qualify for Medicare regardless of age.
ALS (Lou Gehrig's Disease)
If you are diagnosed with ALS, you are automatically enrolled in Medicare Parts A and B starting the first month you receive disability benefits.
Get Your Free Medicare Quote
A licensed NJ Medicare advisor will review your options and tell you exactly which plans you qualify for — always free, no obligation.