Medicare & health insurance, in plain English.
Guides, enrollment calendars, glossary, checklists, and tools — everything NJ residents need to understand their coverage options.
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Guides for every situation
Written by licensed NJ advisors — not generated from generic templates.
Medicare basics
Parts A, B, C, and D explained — what each covers, what it costs, and how the pieces fit together. Includes Medigap and Special Needs Plans.
Learn moreTurning 65 — new to Medicare
Everything to do before your 65th birthday: the 7-month window, Parts A/B/C/D, Medigap vs. Advantage, and the permanent penalties to avoid.
Learn moreHealth insurance / ACA
Marketplace plans on GetCoveredNJ, subsidy eligibility, metal tiers, and how to find a plan that fits your family and budget.
Learn moreMetal tiers & subsidies
How Bronze, Silver, Gold, and Platinum differ — and why picking Silver often unlocks the biggest savings through Cost-Sharing Reductions.
Learn moreSupplemental coverage
Dental, vision, hearing, hospital indemnity, critical illness, and life insurance — filling the gaps your primary plan leaves open.
Learn moreSmall group plans
NJ small-group health coverage for businesses with 1–50 employees. We compare carrier options and handle the enrollment paperwork.
Learn moreEnrollment calendar
Key dates & enrollment windows
Miss a window and you may wait a full year — or face a permanent penalty. Know your dates.
Who: Anyone already enrolled in Medicare
Switch, join, or drop a Medicare Advantage or Part D plan. Return to Original Medicare.
Who: Anyone enrolled in a Medicare Advantage plan
Switch to a different MA plan or return to Original Medicare (+ Part D). One change only.
Who: Turning 65 (or becoming newly eligible)
Enroll in Medicare Part A, Part B, a supplement, and/or Part D for the first time.
Who: NJ residents seeking individual or family marketplace coverage
Enroll, switch, or renew an ACA marketplace plan. Subsidy eligibility recalculated.
Who: Anyone who loses coverage, moves, marries, has a child, or experiences other qualifying events
Enroll or change coverage outside of standard open enrollment windows.
Not sure which window applies to you? Ask our concierge or call (201) 633-7713.
Glossary
Insurance terms, plain English
The 17 terms that come up most in every Medicare and ACA conversation.
Looking for a full A–Z glossary? View the complete glossary →
Checklists
Step-by-step action lists
Print one out or bookmark it — these cover the most common transitions in health coverage.
AEP checklist
Medicare Annual Enrollment · Oct 15 – Dec 7
- Pull your current plan's Annual Notice of Change (ANOC) — mailed each September
- Verify your doctors are still in-network for the coming year
- Run your medications through the plan's 2026 formulary — tier and cost may have changed
- Compare total yearly cost (premium + deductible + expected copays) — not just the monthly premium
- Check the plan's CMS star rating for quality and customer service
- Review dental, vision, and hearing benefits if you use them
- If switching, confirm your new plan covers any scheduled procedures
- Submit enrollment by December 7 — changes take effect January 1
New to Medicare at 65
First-time enrollment · 7-month IEP window
- Find out your 7-month Initial Enrollment Period start date (3 months before your birthday month)
- Check whether your employer plan is creditable coverage — if so, you may delay Part B without penalty
- Enroll in Part A as soon as eligible (usually no premium if you have 40+ work quarters)
- Decide: Original Medicare + Medigap + Part D, or Medicare Advantage (MAPD)?
- If choosing Medigap, enroll during your 6-month guaranteed-issue window (starts when Part B begins)
- Verify your current doctors accept Medicare before choosing a plan
- Run your medications through Part D formularies and compare plan costs
- Stop HSA contributions before your Medicare start date to avoid tax penalties
- Notify Social Security — Part B enrollment may be automatic or require an application
Switching plans checklist
Changing carriers or plan types
- Confirm your new plan's effective date before canceling the old one — never have a gap
- Verify your doctors, specialists, and preferred hospital are in-network on the new plan
- Check that your medications are on the new formulary at an acceptable tier
- Compare deductibles — a lower premium isn't always cheaper if the deductible is much higher
- If switching from Medigap to Medicare Advantage in NJ, note you may face underwriting to switch back
- Keep your old insurance card until your new coverage is confirmed
- Notify any providers of the change so billing is routed correctly from day one
Tools
Find your plan & estimate your costs
All tools are at no cost. No account required to start.
Medicare plan finder
Compare Medicare Advantage, Part D, and supplement plans available in your NJ county.
Learn moreHealth insurance finder
Estimate your ACA subsidy and compare NJ marketplace plans by total yearly cost.
Learn moreAI concierge
Answer a few questions and get a plan recommendation with a full TrueCost™ breakdown — available 24/7.
Learn moreTalk to an advisor
Prefer a real person? Reach a licensed NJ advisor Mon–Sun 8 AM – 9 PM at no cost.
Learn moreOfficial sources
Government & independent resources
We're an independent brokerage — not affiliated with or endorsed by any government agency. These links go to official government and nonprofit sites.
Medicare.gov
Official federal Medicare site. Compare plans, view your coverage, and access your Medicare Summary Notice.
1-800-MEDICARE
The official Medicare helpline (1-800-633-4227), available 24 hours a day, 7 days a week. TTY: 1-877-486-2048.
Get Covered NJ
New Jersey's official ACA marketplace. Enroll in individual and family health plans and check your subsidy eligibility.
NJ SHIP
NJ's State Health Insurance Assistance Program provides no-cost, unbiased Medicare counseling from trained volunteers.
Social Security Administration
Enroll in Medicare, check your Social Security benefits, and apply for Extra Help / LIS at ssa.gov.
CMS Medicare & You handbook
The official annual Medicare handbook — mailed to beneficiaries each fall and available online year-round.
Yumi Health is an independent licensed brokerage. We are not a government site and are not affiliated with Medicare, CMS, or any government agency.
Common questions
Frequently asked questions
The questions we hear most from NJ residents. Click any question to read the answer.
Do I need a referral to see a specialist?+
It depends on your plan type. HMO plans typically require a referral from your primary care provider. PPO plans let you see specialists directly — in or out of network. Medicare Advantage plans vary by carrier; check your Evidence of Coverage. Original Medicare never requires referrals.
What's the difference between Medicare Advantage and Original Medicare + Medigap?+
Medicare Advantage (Part C) is offered by private insurers, often with lower monthly premiums and extra benefits like dental and vision, but limits you to a plan network. Original Medicare + Medigap gives you coverage with any Medicare-accepting provider nationwide and more predictable costs — but higher monthly premiums. NJ's community rating laws make Medigap especially attractive here.
Am I eligible for a subsidy on an ACA marketplace plan?+
You may qualify for a Premium Tax Credit if your household income is between 100% and 400% of the federal poverty level (and in some cases above 400%). NJ also offers additional state savings through Get Covered NJ. Use our Health Insurance Finder or talk to an advisor to see your exact numbers.
Can I be denied coverage because of a pre-existing condition?+
No. ACA marketplace plans cannot deny coverage or charge you more based on health history. Medigap in NJ also cannot charge more based on your health if you enroll during your guaranteed-issue window. Medicare itself has no underwriting for Parts A, B, or D.
What happens if I miss my Medicare enrollment window?+
Missing your Initial Enrollment Period for Part B — without qualifying employer coverage — triggers a permanent late penalty: 10% added to your premium for every 12 months you delayed. Part D has a similar penalty. These surcharges never go away, so timing matters a lot.
Is there a cost to work with a Yumi Health advisor?+
No. Licensed advisors at Yumi Health are compensated by the insurance carriers — not by you. There is no advisory fee, no obligation, and no pressure to enroll in any particular plan. You pay the same premium whether you use an advisor or enroll directly.
What is a Scope of Appointment form?+
A Scope of Appointment (SOA) is a CMS-required document you sign before any Medicare sales appointment. It lists which plan types (Medicare Advantage, Part D, Medigap, etc.) the advisor is permitted to discuss. It's a consumer protection measure — not a commitment to enroll.
What is IRMAA and how do I know if I owe it?+
IRMAA is an income-based surcharge on Medicare Part B and Part D premiums. If your income from two years ago exceeded certain thresholds (~$106,000 for a single filer in 2026), you'll pay more. Medicare sends a notice if you owe IRMAA. You can appeal if your income has since dropped due to a life-changing event.
Still have questions? We're here.
Talk to a licensed NJ advisor at no cost — or let our AI concierge compare plans in minutes.