Understanding Medicare
A licensed Medicare advisor reviews your age, health needs, and budget — then tells you exactly which Medicare Advantage, Medigap, and Part D plans you qualify for in plain language.
Check My Medicare EligibilityThe 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 inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people pay no premium if they or their spouse paid Medicare taxes for 10+ years.
Part B
Medical Insurance
Covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health services. The standard monthly premium is income-based.
Part C
Medicare Advantage
An alternative to Original Medicare offered by private insurers. Bundles Parts A, B, and usually D into one plan. Often includes extra benefits like dental, vision, and hearing.
Part D
Prescription Drug Coverage
Covers the cost of prescription drugs. Available as a standalone plan with Original Medicare, or bundled into most Medicare Advantage plans. Formularies vary by plan.
Medigap
Medicare Supplement
Supplemental policies sold by private insurers that help pay for out-of-pocket costs Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles.
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.
Prefer the self-serve path? Use our Medicare Planner