By Mike Miligi, Certified Medicare Insurance Planner- Michael M Insurance Services
Ocean County isn’t one town — it’s Toms River, Brick, Lakewood, Jackson, Beachwood, Berkeley Township,
Manchester, Stafford, Barnegat, and a dozen more communities stretched along the Jersey Shore, each with
its own mix of hospitals, doctors, and Medicare Advantage plans. That’s exactly why the Annual Enrollment
Period deserves more attention here than a national “here’s how AEP works” article can give it. What fits a
neighbor in Toms River may not fit you in Manchester, even if you’re both looking at a plan with the same
name.
What Is the Annual Enrollment Period?
The Medicare Annual Enrollment Period (AEP) runs every year from October 15 through December 7, with
any changes taking effect January 1. During this window, you can switch Medicare Advantage plans, move
between Original Medicare and Medicare Advantage, or change your Part D prescription drug plan. It’s the one
guaranteed opportunity most Medicare beneficiaries get each year to make a full review of their coverage —
and for Ocean County specifically, it currently covers a lot of ground: 36 Medicare Advantage plans, plus 11
additional Special Needs Plans, 10 Medicare Supplement plans, and 12 stand-alone Part D plans, for
the 2026 plan year. Those exact counts shift somewhat every year as carriers add or drop plans, but the
number of choices has consistently been large enough that comparing matters more than defaulting
The Two Hospital Systems Behind Most Ocean County Plans
Before comparing premiums or star ratings, it’s worth understanding the hospital landscape your plan sits on
top of. Ocean County is largely split between two health systems:
- Hackensack Meridian Health — includes Ocean University Medical Center (Brick) and Southern Ocean Medical Center (Manahawkin)
- RWJBarnabas Health — includes Community Medical Center (Toms River) and Monmouth Medical Center’s Southern Campus (Lakewood)
Some Medicare Advantage plans align cleanly with one system; others include both. A plan that works perfectly
for a Brick Township resident whose specialists are all at Ocean University Medical Center could leave a Toms
River resident, who sees doctors through Community Medical Center, out of network entirely — even in the
same county, on paper-similar plans. This is exactly the kind of detail a premium comparison alone won’t
surface.
Why AEP Matters More Than a Renewal Notice Suggests
A useful local example: Braven Health — a joint venture between Horizon Blue Cross Blue Shield of NJ,
Hackensack Meridian Health, and RWJBarnabas Health — has become the most-enrolled Medicare
Advantage plan in Ocean County, with its Braven Medicare Choice (PPO) covering roughly 12,000 local
members. A joint venture like this is relatively new to the market, which means its network, cost-sharing, and
extra benefits are more likely to shift from year to year than an established plan’s would. If you’re enrolled in a
newer plan like this — or any plan tied to a still-evolving carrier partnership — reading the Annual Notice of
Change (ANOC) each September matters even more than usual.
New Jersey's Medigap Rules Aren't the Same as New York's
This is worth knowing if you or a neighbor has ever compared notes with someone in New York: the two states
play by different rules entirely when it comes to Medicare Supplement (Medigap) plans.
New Jersey follows the federal six-month Medigap Open Enrollment window — starting the month you’re
both 65 or older and enrolled in Medicare Part B. During that window, insurers must sell you any Medigap plan
sold in the state, regardless of health history. Miss that window, and New Jersey insurers are generally allowed
to medically underwrite your application — meaning you could be charged more, or denied altogether, based
on your health.
New York, by contrast, guarantees Medigap issue year-round. That difference matters most if you’re thinking
about switching from Medicare Advantage back to a Medigap plan after your first year or two: in New Jersey,
that switch isn’t automatic the way it would be for a New York resident, unless you qualify for a specific
guaranteed issue right (such as your Medicare Advantage plan leaving the area, or being within your own trial
right period). There is pending New Jersey legislation (A2301/S2592) that would move the state toward
continuous Medigap enrollment, but as of now it has not been enacted — so the six-month window is still the
rule to plan around.
The Medicare Calendar at a Glance
| Window | When It Runs | What It's For |
|---|---|---|
| Initial Enrollment Period (IEP) | 7-month window around your 65th birthday | First-time Medicare enrollment |
| Annual Enrollment Period (AEP) | October 15 – December 7, every year | Full range of plan changes for anyone on Medicare |
| Medicare Advantage Open Enrollment (MA OEP) | January 1 – March 31, every year | One additional switch, only if you're already in a Medicare Advantage plan |
| Medigap Open Enrollment | One-time, 6-month window starting at 65 + Part B | Guaranteed-issue Medigap purchase, regardless of health |
Common AEP Pitfalls for Ocean County Residents
- Assuming your hospital system carries over. A plan that covered your Hackensack Meridian doctors last year isn’t guaranteed to still include them this year.
- Comparing plans by premium alone, without checking whether your specific specialists and medications are actually covered.
- Skipping the ANOC letter, especially on newer plans like Braven Health, where year-over-year changes tend to be more frequent than on long-established carriers.
- Assuming Medigap works the same as it does in New York. In New Jersey, timing your Medigap decision around your six-month window matters far more.
- Missing the December 7 deadline — there’s no grace period, and the narrower Medicare Advantage Open Enrollment Period that follows on January 1 isn’t a full substitute.
Your AEP Checklist for Ocean County Residents
- Read your ANOC letter the week it arrives, especially if you’re on a newer or joint-venture plan.
- Identify which hospital system your doctors are actually part of — Hackensack Meridian, RWJBarnabas, or a mix of both.
- Pull your medication list and check it against your plan’s formulary for the coming year.
- Compare more than one plan. With dozens of options across the county, the first plan that looks reasonable rarely is the best fit.
- If you’re considering Medigap, check your enrollment timing first — New Jersey’s underwriting rules outside your six-month window are far less forgiving than New York’s.
- Decide before December 7, with enough buffer to confirm your enrollment in writing
Frequently Asked Questions
How many Medicare Advantage plans are available in Ocean County?
For the 2026 plan year, Ocean County residents have access to 36 Medicare Advantage plans, plus 11
additional Special Needs Plans for those who qualify for both Medicare and Medicaid or manage a chronic
condition. That count shifts somewhat every year, but it’s consistently large enough that a side-by-side
comparison matters more than picking the first plan you come across.
Does it matter whether I use Hackensack Meridian or RWJBarnabas doctors?
Yes. Some Medicare Advantage plans are built around one system more than the other, and a plan that works
well for a neighbor who sees RWJBarnabas doctors in Toms River may not cover your Hackensack Meridian
specialists in Brick or Manahawkin as well. It’s worth confirming your specific doctors and hospital against a
plan’s current-year network rather than assuming county-wide coverage.
Is Braven Health a good plan?
It depends on your specific doctors and needs, the same as any plan — but it’s worth knowing Braven Health
is a newer joint venture between Horizon BCBSNJ, Hackensack Meridian, and RWJBarnabas, which makes it
the most-enrolled plan locally. Newer plans and joint ventures can see more year-to-year changes in network
and benefits than long-established carriers, so it’s worth reading the ANOC closely if you’re enrolled in one.
I heard Medigap works differently in New Jersey than in New York — is that true?
Yes. New York guarantees Medigap issue year-round, while New Jersey follows the federal rule of a one-time,
six-month guaranteed-issue window starting when you turn 65 and enroll in Part B. Outside that window, New
Jersey insurers can generally medically underwrite a Medigap application, meaning approval and pricing aren’t
guaranteed. This is worth factoring in heavily if you’re weighing Medicare Advantage against a Medigap plan.
Can I switch from Medicare Advantage back to Medigap in New Jersey without medical underwriting?
Not automatically. Unless you qualify for a specific guaranteed issue right — such as your plan leaving your
service area, or you’re within your Medicare Advantage trial right period — a New Jersey insurer can ask
health questions and potentially deny coverage or charge more. This is a meaningfully different situation than
in guaranteed-issue states, so it’s worth planning the timing carefully rather than assuming the switch will go
smoothly.
What if I qualify for both Medicare and Medicaid?
United Healthcare and other carriers offer Dual Special Needs Plans (D-SNPs) in Ocean County for people
who qualify for both Medicare and Medicaid. These plans coordinate benefits between the two programs rather
than leaving you to manage them separately.
Are there local options for managing a chronic condition like diabetes or heart disease?
Yes. Humana Gold Plus – Diabetes and Heart is an example of a Chronic Condition Special Needs Plan (C
SNP) available locally, built specifically around managing those conditions with a tailored formulary and
required care coordination.
What happens if I miss the December 7 deadline?
If you’re already enrolled in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period
(January 1 – March 31) gives you one more narrower opportunity to switch. Otherwise, you’re generally waiting
for the next AEP, unless a qualifying life event opens a Special Enrollment Period.
Can I keep my plan if I move to a different Ocean County township?
Usually, yes — Medicare Advantage plans are approved at the county level, so a move within Ocean County
typically doesn’t affect your plan. Moving to a different county or state generally does, so it’s worth confirming
your new address against your plan’s service area before any move.
Get a Comparison Built Around Your Doctors, Not Just Your ZIP Code
Between two hospital systems, a fast-growing joint-venture plan, and Medigap rules that don’t work the way
they do just across the state line, Ocean County’s Medicare landscape has more moving parts than most. If
you want a comparison built around your actual doctors, medications, and township — not a generic “top-rated
plan” list — I can put one together for you at no cost. You can see more about how I work with Ocean County
residents on my
Ocean County Medicare Broker page.
Mike Miligi
Owner, Michael M Insurance Service
For over 10 years, Mike has helped seniors and other Medicare-eligible individuals understand their options, including
Medicare Advantage Plans (Part C), Medicare Supplement Plans (Medigap), Prescription Drug Plans (Part D), and dental
and vision programs. Mike is licensed in seven states and certified with 11 insurance carriers. As an independent
Medicare health insurance broker, he works for the client, not the insurance carriers, providing accurate, unbiased
options. Mike recertifies with CMS annually and completes continuing education to stay current on industry standards.
(631) 774-3786 | mmilinsurance@gmail.com | www.mymedicaremike.com
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