Medicare 2026

Medicare in Paterson: Medigap and Advantage compared

PATERSON, N.J. — For people turning 65 or already on Medicare here in Paterson, the choice between Original Medicare with a Medigap policy and a Medicare Advantage plan is not just about coverage. It is about the calendar. Miss the right window, and the door you wanted to walk through may close — or open only with strings attached.

The two paths are built differently, and the deadlines that govern them are different too. Knowing which clock is ticking can save a lot of frustration later.

Two structures, two sets of deadlines

Original Medicare (Parts A and B) is the federal program. A Medigap (Medicare Supplement) policy is sold by a private insurer and helps pay the out-of-pocket costs Original Medicare leaves behind. A stand-alone Part D plan covers prescriptions.

Medicare Advantage (Part C) is different. It is a private plan that replaces the way you get your Part A and Part B benefits, usually bundles drug coverage, and often uses a network of doctors and hospitals.

Because the structures differ, so do the enrollment rules. Medigap has its own one-time federal protection window. Advantage and Part D follow Medicare's annual calendar.

The Medigap window you only get once

The strongest consumer protection in Medigap is short. When you first turn 65 and enroll in Part B, a six-month Medigap Open Enrollment Period begins. During those six months, insurers in most states must sell you any Medigap policy they offer at their best available rate, and they cannot turn you down or charge more because of your health history.

After that window closes, medical underwriting generally applies. That means an insurer can review your health and, in most states, decline to cover you or charge more. A handful of states have broader rules — New Jersey residents can call the state's SHIP counselors (see below) to confirm what applies here.

The takeaway: if you think you may ever want a Medigap policy, the safest time to buy one is during that first six-month window.

The annual windows for Advantage and Part D

Two federal windows drive most Advantage and drug-plan decisions each year:

• Annual Enrollment Period (AEP): Oct. 15 – Dec. 7. During AEP, you can join, switch, or drop a Medicare Advantage plan, and you can join, switch, or drop a Part D drug plan. Changes take effect Jan. 1.
• Medicare Advantage Open Enrollment Period (MA-OEP): Jan. 1 – March 31. If you are already in an Advantage plan on Jan. 1, you get one chance during this window to switch to a different Advantage plan or drop back to Original Medicare (and pick up a stand-alone Part D plan). This window is not for people in Original Medicare who want to move into Advantage.

If you miss both, you typically wait until the next AEP unless you qualify for a Special Enrollment Period — for example, if you move out of your plan's service area or lose other coverage.

When the two calendars collide

The trickiest situations are the ones where the Medigap clock and the Advantage clock don't line up.

Say a Paterson resident chooses Medicare Advantage at 65, then during MA-OEP two years later decides to return to Original Medicare. They can drop the Advantage plan between Jan. 1 and March 31, but their six-month Medigap guarantee is long gone. Whether they can buy a Medigap policy at that point — and at what price — depends on state rules and, in some cases, "trial right" protections for people who tried Advantage for the first time.

The lesson is simple: the decision to try Medicare Advantage is easier to make than to undo. Ask about state rules before you assume you can switch back later.

Part D deadlines and the 2027 numbers

Prescription drug coverage runs on the same AEP calendar. A few 2027 program facts worth keeping in mind:

• Part D has a $2,400 out-of-pocket cap on covered drugs in 2027, up from $2,100 in 2026.
• The maximum Part D deductible is $700 in 2027, compared with $615 in 2026.
• The coverage gap (the old "donut hole") was eliminated in 2025, so Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments instead of paying at the pharmacy counter.
• IRMAA income-related surcharges for Part B and Part D begin above $109,000 in income for a single filer in 2026.

Missing the AEP deadline to add Part D — and going without other creditable drug coverage — can also trigger a late enrollment penalty that stays with you.

Paterson and Passaic County

Paterson is in Passaic County, and Medicare Advantage and Part D plan availability is set at the county level. That means the menu of plans offered here is the same across the county, though provider networks and pharmacies vary. Availability changes each year, which is why CMS builds the AEP window into every fall.