The two main roads
Most people pick one of two paths. On the first, you keep Original Medicare, which is Parts A and B.
Then you add a Medigap plan and a separate Part D drug plan. On the second, you join a Medicare Advantage plan, which replaces Original Medicare and often includes drug coverage.
You cannot mix the two. If you have a Medicare Advantage plan, you cannot also use Medigap. Read more in our guides to Medigap and Medicare Advantage.
What each road tends to look like
The table below describes patterns, not prices. Costs vary by plan, by insurer and by your health.
| Feature | Original Medicare with Medigap and Part D | Medicare Advantage |
|---|---|---|
| Monthly premiums | Part B premium, a Medigap premium and a Part D premium | Part B premium, plus a plan premium that may be low or zero |
| Doctors | Any doctor who accepts Medicare | Usually a plan network |
| Referrals | Not needed | Some plans require them |
| Yearly limit on what you pay | Medigap may cover most cost-sharing | Verify current amount and eligibility |
| Prescription drugs | Separate Part D plan | Often included in the plan |
| Dental, vision, hearing | Not included | Often included in some form |
| Travel in the U.S. | Works anywhere that accepts Medicare | Depends on the plan |
| Prior approval | Rarely | Often for some services |
The Medicare Advantage limit comes from Medicare.gov current cost information. Check your own plan, since many set lower limits.
The costs that do not change
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.
If you pay no Part A premium, that cost is zero either way. Compare costs under both roads from the same starting line.
Cost 2: deductibles and copays
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.
Look at what you use. If you see a specialist often, add up the copays.
If you expect a hospital stay, look at the daily charge. The numbers differ widely between plans.
Cost 3: the most you could pay
Medigap premiums vary by insurer, policy and eligibility. Compare the same lettered policy and confirm current prices, underwriting rules and any costs the policy does not pay.
Think about a bad year, not a typical year. If a major illness happened, how much could you handle? That is your comfort level.
Cost 4: prescription drugs
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.
Use Plan Finder to enter every drug and your pharmacy. Compare each plan's estimate of your total drug cost, and check the drug tier for each medicine.
Cost 5: the costs people forget
Some costs hide outside the premium and deductible.
- Out-of-network care: Many Advantage plans pay little or nothing for care outside the network, except in an emergency.
- Extra benefits: Dental or hearing benefits may be capped at a small yearly amount.
- Time away: If you spend part of the year in another state, check how the plan covers you there.
- Prior approval: Some services need a plan's permission first, which can take time.
A worksheet you can fill in
Use the same worksheet for each plan you are considering. Fill in your numbers from the plan documents, not from memory.
| Line | Plan 1 | Plan 2 | Plan 3 |
|---|---|---|---|
| Monthly premiums times 12 | |||
| Medical deductible | |||
| Copays for the visits you expect | |||
| Drug costs for the year | |||
| Out-of-pocket limit | |||
| Doctors in network? | |||
| Pharmacy in network? | |||
| Extras you will use | |||
| Yearly total |
Add the rows for a yearly total. Then look at the limit row, to see the worst case.
Plan cost comparison in Brick, NJ: other things to weigh
Money is one part of the choice. Your doctors, your hospital and your comfort with rules matter too.
Ask which hospitals are in each plan's network, and check where your regular doctors practice. Many people also value being able to see any doctor, while others like having one card for everything.
Does New Jersey help lower your costs?
Some people may get state help. A Medicare Savings Program may pay your Part B premium.
Extra Help can lower drug costs, and PAAD can help with prescriptions. Check these first, because they may change which plan makes sense.
When you can switch
Your first choice is not always your last. Each fall, you can review and change your coverage from October 15 to December 7.
Medigap rules are different, and switching later may need health questions. See enrollment periods for your options.
Keep reading
This page is part of the Coverage & Costs library, inside our Medicare insurance guide for Brick, NJ. Related pages:
Unfamiliar word? Check the Medicare glossary.
Compare your own numbers with an insurance professional
Every household uses care differently. An insurance professional can help you fill in your own worksheet and explain plans available where you live.
Frequently Asked Questions
Is Medicare Advantage cheaper than Medigap?
It depends on how you use care. Advantage plans often have lower premiums but more copays. Medigap often has higher premiums and fewer bills when you get care.
What is the most I can pay with Medicare Advantage ?
Coverage costs and program limits can change. Use current official information and the exact plan documents rather than treating one year's figures as a permanent estimate.
Does Original Medicare have a yearly limit?
No. That is one reason many people add Medigap.
Should I compare more than the premium?
Yes. Look at deductibles, copays, the yearly limit, drug costs and your doctors.
Where can I compare plans in Brick, NJ?
Use Plan Finder at Medicare.gov, or call an insurance professional at (732) 641-1183.