As you navigate Medicare plans and options, you need a little bit of knowledge for each step of the way: when to enroll, which plan to choose, what is covered and not covered, how to switch plans, and information about other intricacies about Medicare. It may be tough and time-consuming to ask Medicare directly, so below find Medicare questions answered that patients most often ask.
New Jersey Medicare recipients are typically age 65 and over or on Social Security disability for two years.
There is never a charge to you for working with New Jersey Medicare Brokers. The benefit to working with a Broker is that you can shop the market for the best plan for your specific needs. We are compensated by the insurance companies after you enroll in a plan through us. The price of the plans available is the same whether you work with us or go directly through the insurance company.
If you have private insurance that you’re happy with, in most cases you don’t have to enroll in Medicare Part B until you retire or lose your benefits. There are certain rules based on the size of your employer, so it's best to work with a Broker who can help you navigate this process. The enrollment period for Medicare after leaving/losing employer coverage is time sensitive so it is best to work with a Broker to make sure you do not miss your enrollment window.
It depends on the type of plan you have, when you qualified for it, and whether you receive any extra help with drug costs. Most of the time you can only switch Medicare Advantage plans (Part C) and prescription drug plans (Part D) during the Annual Enrollment period, which is October 7 through December 15 of every calendar year. It is also possible to make certain changes to plans during January 1 through March 31.
If you want to make changes to your Medicare Supplement or Medigap plan, you can usually do this any time of year, but medical underwriting may apply.
Medicare Part A covers hospital visits; Part B covers doctor’s visits, lab tests, and procedures; Part D covers prescription drugs. Medicare Part C (Medicare Advantage) is a combination of Part A, B, and D and additional benefits through a private insurance company and is typically an HMO or PPO.
Original Medicare (Parts A or B) has a different fee structure than Medicare Advantage (Part C). For example, Original Medicare has a 20% coinsurance for a doctor whereas Medicare Advantage may have a copay which varies based on the plan. Original Medicare include medications and must be added on separately, but Medicare Advantage does. Finally, Original Medicare does not have a network of doctors and hospitals, but Medicare Advantage is typically HMO or PPO meaning you must stay in a network of doctors and hospitals.
There are Medicare supplemental (or Medigap) plans that can help with additional costs if someone chooses to keep Original Medicare. Medicare Part A and B, each have out-of-pocket costs like copays and deductibles. A supplemental plan bridges the gap to cover these costs, as well as other expenses, for a monthly premium.
Some Medicare Advantage plans (Part C) are offered at $0 monthly fee. This means that you pay $0/month in addition to your Part B premium. You must continue to pay your Medicare Part B premium with these plans. We explain this in greater detail in
With Medicare Advantage plans, the private insurance company takes over managing your healthcare and Medicare pays the insurance company a monthly stipend to do so. This “monthly stipend” is based on the county you live in and the star rating of the plan.