Medicare annual enrollment runs October 15 to December 7, and for many New Jerseyans the most important question is simple: are my doctors in the plan’s network next year? During these weeks you can join, switch, or drop a Medicare Advantage plan or a Medicare drug plan, or move between Original Medicare and Medicare Advantage. The plan must get your request by December 7 for coverage that starts January 1. This checklist works the same in Hackensack, Paterson, Newark, Elizabeth, Edison, Toms River, Trenton, Cherry Hill, Atlantic City, or Cape May.
This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in New Jersey and certified as a broker with Get Covered New Jersey. We are not Medicare, CMS, Get Covered New Jersey, the State of New Jersey, or an insurance company, and we do not quote prices or name plans here. Check official dates on Medicare.gov.
The short answer
- Make a list of every doctor, specialist, hospital, and pharmacy you use.
- Confirm each one with the office and the plan for next year, not this year.
- Know which kind of coverage you have, Medicare Advantage or Original Medicare with a Medigap policy, because the rules for doctors are different.
Step 1: Read your Annual Notice of Change
Your plan mails it each fall. Look for changes to the provider network, the drug list, and rules such as referrals or prior authorization. Then compare in Medicare.gov Plan Finder if anything affects you.
Step 2: Check the network, one name at a time
Medicare.gov says to ask your doctors and pharmacies whether they’re in network with the plan. A few tips that save trouble later:
- Ask about the exact plan name, not just the insurance company.
- Ask about next year, since that is the coverage you are choosing.
- Check the hospital too, along with any specialist you see a few times a year, your lab, and your imaging center.
- Ask about referrals and approvals. Medicare.gov says with Medicare Advantage you may need a referral to see a specialist and approval (prior authorization) before some services.
Medicare.gov says you must live in a plan’s service area to join it, so the plans you can pick in Bergen County may differ from Ocean, Camden, or Cape May County.
See specialists in New York City or Philadelphia?
Many New Jersey residents see specialists across the Hudson or across the Delaware. If you’re in a Medicare Advantage plan, check whether those offices and hospitals are in your plan’s network. Medicare.gov says you may need to use doctors in the plan’s network for non-emergency care, and while some plans cover out-of-network care, it may cost more. With Original Medicare, Medicare.gov says you can use any doctor or hospital that takes Medicare, anywhere in the U.S.
If you live in Pennsylvania or Delaware rather than New Jersey, our agent is not licensed there, so use Medicare.gov or that state’s SHIP counselors through SHIP’s national locator.
Medigap or Medicare Advantage: the basics
Medicare.gov describes the trade-offs this way:
- Original Medicare plus Medigap. Any doctor or hospital that takes Medicare. Original Medicare has no yearly limit on what you pay out of pocket, and a Medigap policy helps pay your share. Medigap policies sold today don’t include drug coverage, so most people add a separate Medicare drug plan.
- Medicare Advantage. A plan from a private company that contracts with Medicare and is an alternative to Original Medicare. Most include drug coverage. Plans have a yearly limit on what you pay for covered services, may require network doctors, and may offer extra benefits like some vision, hearing, and dental.
- You can’t have both. Medicare.gov says you can’t use Medigap to pay Medicare Advantage costs.
Thinking about switching to Medigap? Medicare.gov says your federal Medigap Open Enrollment Period is a one-time, 6-month window that starts the first month you have Part B and are 65 or older. Outside it, a company may be able to deny you or charge more unless you have a guaranteed issue right. One example Medicare.gov gives: if you joined a Medicare Advantage plan when you were first eligible at 65 and switch back to Original Medicare within the first year, you can buy certain Medigap policies. You may have more rights under state law, so ask NJ SHIP before you drop a plan. See Medicare.gov’s ready to buy Medigap page.
Missed the date or something changed?
- Medicare Advantage open enrollment, January 1 to March 31. If you are already in a Medicare Advantage plan, you can switch to another one or go back to Original Medicare and join a drug plan.
- Moving. Medicare.gov says that if you move out of your plan’s service area, your chance to switch starts when you move and lasts for 2 full months after. That includes moving from North Jersey to the Shore, or out of state. See Medicare’s Special Enrollment Periods page.
- Winters in Florida? Medicare.gov says that if you live in another state for part of the year, check whether the plan will cover you there.
Help with costs
New Jersey’s NJSave is an online application that helps low-income seniors and people with disabilities save on Medicare premiums, prescription costs, and other expenses. Medicare.gov also describes Extra Help with Part D costs, which you apply for through Social Security, and Medicare Savings Programs, which you apply for through the state. See Medicare.gov’s Medicare Savings Programs page.
Where to get unbiased help in New Jersey
New Jersey’s State Health Insurance Assistance Program (SHIP) has volunteer counselors who help people with Medicare evaluate their options. The state says they don’t sell, recommend, or endorse any insurance product, agent, company, or plan. Call the SHIP Information Center at 1-800-792-8820, contact your County Office on Aging, or see the NJ SHIP page, which also posts charts of the Medigap, Medicare Advantage, and drug plans offered in New Jersey.
Someone in your house under 65?
If a spouse or adult child needs their own plan, New Jersey residents apply at Get Covered New Jersey, not HealthCare.gov. Open enrollment runs November 1 to January 31, and enrolling by December 31 means coverage starts January 1. Our agent is certified as a broker with Get Covered New Jersey, so we can go through the application with you, compare plans, and help you enroll, at no extra cost to you for our help. We are not Get Covered New Jersey, and Get Covered New Jersey decides what you qualify for. See our New Jersey open enrollment guide.
How we help
We are licensed in New Jersey and can help you compare Medicare Advantage plans, Medigap policies, and drug plans, and enroll if you decide to. We are not Medicare or the government. We help by phone and online, in English or Spanish. Learn more on our New Jersey health insurance help page. We check your doctors, hospitals, prescriptions, and ZIP code, explain the options in plain English, and leave the decision to you. If you are helping a parent, you are welcome on the call too.
Want a second set of eyes before December 7?
Have your Medicare card, your Annual Notice of Change, your doctor list, and your drug list ready, and we can walk through it together.
Call (321) 315-0054 | agent@inshh.com
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 489 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, is available 24 hours a day, 7 days a week, except some federal holidays. Instant Health Help is not connected with or endorsed by the U.S. government or the federal Medicare program.
Featured photo: Cape May Lighthouse from beach by Ebluen, CC BY-SA 4.0, cropped with text added.
