The confusing part is the number of choices that follow. This guide walks through them one at a time, using plain words, for people in Brick Township and Ocean County, NJ.
The four parts of Medicare, in plain words
Think of Medicare as a set of building blocks. You pick the blocks that match your life.
- Part Ais hospital insurance. It covers inpatient hospital stays, skilled nursing after a hospital stay, hospice and some home health care. Most people pay no monthly premium for it. Read.
- Part Bis medical insurance. It covers doctor visits, outpatient care, lab tests and preventive screenings. You pay a monthly premium. Read.
- Part Cis Medicare Advantage. A private company runs your Part A and B benefits, usually with drug coverage added. See.
- Part Dis prescription drug coverage. Private companies sell it. See.
Medigap is a fifth piece, sold by private companies. It pays some of what Original Medicare leaves behind, like deductibles and coinsurance. See Medigap plans.
Two roads: Original Medicare or Medicare Advantage
Almost every decision comes down to one fork in the road. Parts A and B together are Original Medicare.
You can keep them and add Medigap and Part D. Or you can swap them for one Medicare Advantage plan.
| Original Medicare, plus Medigap and Part D | Medicare Advantage | |
|---|---|---|
| Cards you carry | Medicare card, Medigap card, drug plan card | Usually one plan card, plus your Medicare card |
| Choice of doctors | Any provider in the U.S. that accepts Medicare | Plan network rules apply |
| Referrals | Not needed | Some plans need them |
| Yearly cap on covered medical costs | None in Original Medicare; depends on the Medigap plan you pick | Every plan has one |
| Extras like dental or vision | Not included in Original Medicare | Often included in some form |
| Costs during the year | Higher premiums, steadier costs at the doctor | Lower premiums are common, copays when you use care |
Neither road is better for everyone. The right one depends on how you use health care and how much you want to know your costs in advance. Our plan cost comparison page shows how to weigh them.
What Medicare costs, and what is coming
Costs change each year. These are the current figures from Medicare.gov, with the year shown on each.
- Part B has a monthly premium and other cost-sharing rules. Some people pay an income-related adjustment. Check Medicare's current figures and any notice from Social Security before budgeting.
- Part A costs depend on work history, the type of care and the applicable benefit period. Check current Medicare amounts and the coverage conditions before estimating your share.
- Drug-plan premiums, deductibles and pharmacy costs vary. Review current plan documents using your exact prescriptions, doses and preferred pharmacy.
- Drug-plan premiums, deductibles and pharmacy costs vary. Review current plan documents using your exact prescriptions, doses and preferred pharmacy.
Medicare has not yet published the Part B premium and deductible as of this review. Check Medicare.gov costs for updates.
Which path fits me? A four-question check
Answer these in your head. They point you toward the pages most likely to help.
Do you want to keep any doctor in the country, with no network to think about?
If yes, read about Medigap.
Would you rather pay a lower monthly premium and accept network rules?
If yes, read about Medicare Advantage.
Is money tight right now?
If yes, read New Jersey help paying for Medicare before you pick anything.
Do you or your spouse still work for an employer?
If yes, read working past 65 first.
These questions are a starting point, not advice. A insurance professional can help you go deeper.
When you can sign up or change plans
Medicare gives you specific windows. Outside them, changes are limited.
- Initial Enrollment Period: seven months, starting three months before the month you turn 65.
- Open enrollment, October 15 to December 7: switch plans for the the following year.
- Medicare Advantage Open Enrollment, January 1 to March 31: if you are in an Advantage plan, make one change.
- General Enrollment, January 1 to March 31: sign up for Part B if you missed your first window. Late penalties may apply.
- Special Enrollment Periods: certain events, such as moving or losing job coverage, open a window.
The page on enrollment periods lays out each window with what you can and cannot change.
What Original Medicare does not cover
Original Medicare leaves some real gaps. Knowing them early helps you plan.
- Most routine dental care, dentures and cleanings
- Routine eye exams and glasses
- Hearing aids and hearing exams
- Long-term custodial care, such as help with bathing and dressing in a nursing home
- Most care received outside the United States
Some Medicare Advantage plans add dental, vision or hearing benefits. Medigap does not. See our page on dental, vision and hearing for ways to fill these gaps.
Penalties you can avoid
Waiting has a price in Medicare. The Part B late penalty adds 10% for every full 12 months you could have had Part B and did not. You pay it for as long as you have Part B.
The Part D late penalty works differently. It is 1% of a national base premium for each month you went without drug coverage.
Both penalties are avoidable if you plan ahead. The page for turning 65 shows how.
Medicare insurance help in Brick, NJ: extra things to check
Brick sits on Barnegat Bay and the Metedeconk River, and Ocean County has a large number of retirees and seasonal residents. That shapes real choices.
- Hospitals and specialists. Ocean University Medical Center is in Brick, and other hospitals are nearby. Ask whether each plan includes the hospital and specialists you use.
- Time away. If you spend winters out of state, ask how the plan handles care outside New Jersey.
- Help close to home.New Jersey's State Health Insurance Assistance Program (SHIP) offers counseling at 1-800-792-8820. Ourpage lists the towns we cover.
Four steps to compare plans on your own
You can start before you ever pick up the phone. Here is a simple order that works.
Write down every medicine you take, with the dose and how often.
List your doctors, your hospital and your pharmacy.
Decide on a monthly amount you are comfortable with, and a yearly worst-case amount.
Look up plans on Medicare Plan Finder, then call to talk through the results.
Having this list ready also makes a phone call with an agent much shorter.
Who to ask: an agent, 1-800-MEDICARE or the plan itself
You have three common ways to get answers. They do different jobs.
- 1-800-MEDICARE gives general Medicare information and can tell you what is covered. It does not compare plans for you based on your doctors.
- A plan's own phone line answers questions about that plan only. It cannot compare other plans.
- An insurance professional can explain several plans side by side. Agents are paid by insurance companies if you enroll.
Agents do not offer every plan available in your area. That is why we always point you to Medicare.gov as well. Use all three if you like.
Three myths worth clearing up
"Medicare costs nothing once I turn 65." Part A has no premium for most people. Part B does have one, and you may owe deductibles and coinsurance.
"Medicare pays for all my care." It does not, as the list above shows. That is why many people add Medigap or choose Advantage.
"I can switch plans any time." Most changes are limited to set windows. Missing one can mean waiting until the the following year.
Help paying for Medicare in New Jersey
If you have limited income, New Jersey and the federal government have programs that may lower your costs. Some are easy to miss. Visit the NJ help hub to see all five.
Explore the full Medicare library for Brick
Pick a group, then a topic. Each page ends with answers to common questions.
Getting Started
Coverage & Costs
NJ Help Paying for Medicare
Keep going
If you are just starting, read New to Medicare. If you already have Medicare and want to review your plan, read about the Annual Notice of Change.
Terms you do not know are in the Medicare glossary. For a broader list of trusted sources, see Resources.
Talk your choices through with an insurance professional
You have read the basics. Now put your doctors, medicines and budget on the table and see how the options line up. An insurance professional will take the call and answer your questions.
Frequently Asked Questions
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare is Parts A and B, run by the federal government. Medicare Advantage is a private plan that replaces Parts A and B and usually adds drug coverage. You cannot have both at once.
Do I need Part D if I take few medicines?
Many people do. If you skip it and later need coverage, you may pay a late penalty for as long as you have Part D. Read our Part D guide to see how to avoid it.
How is Medigap different from Medicare Advantage?
Medigap works alongside Original Medicare and pays some of its costs. Medicare Advantage replaces Original Medicare with a private plan. You cannot use both at the same time.
When should I start looking at Medicare options?
About three months before you turn 65. If you already have Medicare, start in October when open enrollment begins.
Where can I double-check what I read here?
Use Medicare.gov and the New Jersey SHIP program. They do not sell plans.