Medicare 2026

Medicare in Woodbridge: Two Structures Behind the Choice

WOODBRIDGE, N.J. — If you are turning 65 in Woodbridge, or helping a parent sort through the mail piling up on the kitchen table, the biggest choice usually comes down to this: stay with Original Medicare and add a Medigap policy, or go with a Medicare Advantage plan. They are two very different structures, and understanding how each one is built makes the rest of the decisions easier.

Path one: Original Medicare plus Medigap

Original Medicare is the traditional program run by the federal government. It has two parts: Part A (hospital) and Part B (doctors and outpatient care). You can see any doctor or hospital in the country that accepts Medicare, and you don't need referrals.

Original Medicare doesn't cover everything, though. There are deductibles, coinsurance, and no yearly cap on what you might pay out of pocket. That is where Medigap — also called Medicare Supplement Insurance — comes in. A Medigap policy is sold by a private insurer and helps pay some of the costs Original Medicare leaves behind, like the 20% coinsurance on Part B services.

Medigap does not include drug coverage. If you go this route, you usually add a stand-alone Part D drug plan.

Path two: Medicare Advantage

Medicare Advantage (Part C) is different. Instead of the government paying your claims directly, you choose a private plan approved by Medicare, and that plan takes over your Part A and Part B coverage. Most Medicare Advantage plans also include Part D drug coverage built in, and many include extras like dental, vision, or hearing.

The trade-off is structure. Medicare Advantage plans usually work through a network of doctors and hospitals, and many require referrals or prior approval for certain services. They also have a yearly out-of-pocket maximum for medical care, which Original Medicare on its own does not.

Woodbridge is in Middlesex County, where residents can compare the Medicare Advantage plans available in the county on Medicare.gov's plan finder.

What's the same on both paths

No matter which path you choose, several 2027 rules apply the same way:

• Part D has a $2,400 out-of-pocket cap on covered prescriptions.
• The Part D deductible cannot exceed $700.
• The old "donut hole" coverage gap is gone as of 2025 — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly payments, if that helps your budget.
• IRMAA surcharges on Part B and Part D begin above $109,000 in income for a single filer in 2026.

How to choose

There is no single right answer. Ask yourself a few honest questions:

• Do you travel often or split time between states? Original Medicare plus Medigap travels well.
• Do you want extras like dental or vision bundled in? That is more common with Medicare Advantage.
• Do you have specific doctors you want to keep? Check whether they are in the plan's network before you enroll.
• How do you feel about referrals and prior authorization versus a broader choice with more paperwork?

Your local State Health Insurance Assistance Program (SHIP) offers free, one-on-one counseling. In New Jersey, that program is called SHIP and it is not tied to any insurance company.

Timing matters

Two windows to remember:

• Annual Enrollment Period: October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you are already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare.

Medigap has its own rules. The best time to buy is during your six-month Medigap Open Enrollment Period, which starts the month you are 65 or older and enrolled in Part B. Miss that window, and insurers in many cases can charge more based on your health.