Medicare Planning Summary

Medicare at Age 65

A side-by-side guide to Original Medicare and Medicare Advantage, with an illustrative household budget for two people.

New Jersey • two people • estimated income under $100,000 • few or no prescriptions

1. Original Medicare vs. Medicare Advantage

Category Original Medicare + Medigap Medicare Advantage (Part C)

Monthly premium Usually higher because you add Medigap and Part D Often lower; some plans have a $0 plan premium (Part B still applies)

Doctor choice Broad access to providers nationwide who accept Medicare Usually limited to plan networks; PPOs may offer out-of-network coverage

Specialists Generally no referrals required Referrals may be required, depending on plan

Hospital choice Any Medicare-participating hospital Network rules generally apply, except for emergencies and other protected situations

Dental / vision / hearing Usually separate coverage or out-of-pocket Often includes some extra benefits; coverage varies

Prescription drugs Usually add a separate Part D plan Often included in the Advantage plan

Out-of-pocket protection Plan G generally covers most Medicare-approved Part A/B cost-sharing, subject to its deductible and rules Annual maximum for covered Part A/B services; copays and coinsurance apply up to that limit

Prior authorization Generally less common for Medicare-covered services May be required for certain services

Travel flexibility Generally stronger nationwide flexibility Routine care may be restricted outside the service area; emergency/urgent care is covered

Short-term vs. long-term: Medicare Advantage often costs less each month. Original Medicare with Medigap generally offers broader provider choice and more predictable medical cost-sharing. The better choice depends on premiums, health needs, provider networks, and the ability to obtain Medigap later.

Category	Original Medicare + Medigap	Medicare Advantage (Part C)
Monthly premium	Usually higher because you add Medigap and Part D	Often lower; some plans have a $0 plan premium (Part B still applies)
Doctor choice	Broad access to providers nationwide who accept Medicare	Usually limited to plan networks; PPOs may offer out-of-network coverage
Specialists	Generally no referrals required	Referrals may be required, depending on plan
Hospital choice	Any Medicare-participating hospital	Network rules generally apply, except for emergencies and other protected situations
Dental / vision / hearing	Usually separate coverage or out-of-pocket	Often includes some extra benefits; coverage varies
Prescription drugs	Usually add a separate Part D plan	Often included in the Advantage plan
Out-of-pocket protection	Plan G generally covers most Medicare-approved Part A/B cost-sharing, subject to its deductible and rules	Annual maximum for covered Part A/B services; copays and coinsurance apply up to that limit
Prior authorization	Generally less common for Medicare-covered services	May be required for certain services
Travel flexibility	Generally stronger nationwide flexibility	Routine care may be restricted outside the service area; emergency/urgent care is covered

2. Illustrative monthly budget for two people

For planning only, below is a sample estimate in future age-65 dollars. Actual premiums will depend on the year, county, insurer, plan, underwriting rules, and each person's circumstances.

Original Medicare + Plan G + Part D

~$960 / month

About $480 per person; a practical planning allowance is approximately $1,000 per month for both.

Medicare Advantage with drug coverage

~$450–$650 / month

Household estimate including Part B and an assumed low or modest plan premium. Copays and cost-sharing vary.

Original Medicare component Illustrative monthly per person Both people

Part A – hospital $0* $0*

Part B – medical $225 $450

Medigap Plan G $220 $440

Part D – prescriptions $35 $70

Estimated total $480 $960

*Assumes each person qualifies for premium-free Part A through sufficient Medicare-covered work history. The amounts above are estimates, not 2029 quotes or guaranteed premiums. They exclude dental, routine vision, hearing aids, and other noncovered expenses.

Important: The Advantage estimate is not an apples-to-apples guarantee of total annual cost. Compare each plan's provider network, drug formulary, deductible, copays, coinsurance, and annual out-of-pocket maximum—not just its monthly premium.

Original Medicare component	Illustrative monthly per person	Both people
Part A – hospital	$0*	$0*
Part B – medical	$225	$450
Medigap Plan G	$220	$440
Part D – prescriptions	$35	$70
Estimated total	$480	$960

3. Medicare parts explained

Part / plan What it covers Planning note

Part A Inpatient hospital, skilled nursing facility (limited qualifying coverage), hospice, some home health Enroll; often premium-free with sufficient work credits.

Part B Doctors, outpatient care, preventive services, durable medical equipment Enroll; monthly premium applies.

Part C Medicare Advantage: private-plan alternative that provides Part A and Part B benefits Alternative to Original Medicare, not an add-on to it.

Part D Outpatient prescription drugs Usually a separate plan with Original Medicare; often bundled with Advantage.

Medigap Supplemental insurance that helps pay certain Original Medicare cost-sharing Plan G and Plan N are common options to compare. Medigap cannot be used with Medicare Advantage.

Part / plan	What it covers	Planning note
Part A	Inpatient hospital, skilled nursing facility (limited qualifying coverage), hospice, some home health	Enroll; often premium-free with sufficient work credits.
Part B	Doctors, outpatient care, preventive services, durable medical equipment	Enroll; monthly premium applies.
Part C	Medicare Advantage: private-plan alternative that provides Part A and Part B benefits	Alternative to Original Medicare, not an add-on to it.
Part D	Outpatient prescription drugs	Usually a separate plan with Original Medicare; often bundled with Advantage.
Medigap	Supplemental insurance that helps pay certain Original Medicare cost-sharing	Plan G and Plan N are common options to compare. Medigap cannot be used with Medicare Advantage.

4. Plan G vs. Plan N

Feature Plan G Plan N

Monthly premium Usually higher Usually lower

Part B deductible You pay it You pay it

Doctor / outpatient copays Generally covered after the Part B deductible Some office and emergency-room copays may apply

Part B excess charges Covered Not covered

Good fit People who prefer fewer bills at the point of care People willing to accept some cost-sharing for a lower premium

Benefits are standardized by plan letter, but premiums and availability vary by insurer and state. Compare the actual New Jersey policy details.

Feature	Plan G	Plan N
Monthly premium	Usually higher	Usually lower
Part B deductible	You pay it	You pay it
Doctor / outpatient copays	Generally covered after the Part B deductible	Some office and emergency-room copays may apply
Part B excess charges	Covered	Not covered
Good fit	People who prefer fewer bills at the point of care	People willing to accept some cost-sharing for a lower premium

5. Income and IRMAA

Medicare's income-related monthly adjustment amount (IRMAA) can increase Part B and Part D premiums when income exceeds federal thresholds. Medicare generally uses tax-return information from two years earlier.

With expected household income below $100,000, you may be below the IRMAA thresholds, assuming the relevant tax-year modified adjusted gross income remains similar.

Roth conversions increase taxable income in the conversion year and can affect Medicare premiums two years later.

Check the applicable thresholds and your projected modified adjusted gross income before deciding how much to convert.

A small Roth conversion may still be compatible with staying below an IRMAA threshold, but calculate the full tax-year income rather than relying only on retirement income.

6. Helpful comparison resources

Medicare.gov — Official federal Medicare information and plan finder. Compare Medicare Advantage and Part D plans by ZIP code.

New Jersey SHIP — Free, unbiased Medicare counseling and help comparing coverage. Phone: 1-800-792-8820.

KFF Medicare — Independent health-policy research and Medicare analysis.

Suggested next step: When you are closer to enrollment, compare actual New Jersey Plan G, Plan N, Part D, and Medicare Advantage offerings using your ZIP code, preferred doctors, and prescriptions. A free SHIP counselor can help review the options without selling you a policy.

7. Bottom line

For a balance of cost and coverage, start by comparing Original Medicare + Medigap Plan G or Plan N + Part D against a well-rated local Medicare Advantage plan. If the higher monthly premium is affordable, Original Medicare with Medigap generally provides more provider flexibility and more predictable cost-sharing. Advantage may be attractive if its network includes your doctors and its total expected costs are lower.

Planning reminder: All dollar figures on this page are illustrative estimates, not insurance quotes. Medicare premiums, plan benefits, rules, and state protections can change. Verify current details before enrolling.