Understand Medicare in New Jersey

Medicare, the United States federal medical insurance program, provides coverage for more than 1 million people in New Jersey who qualify for Medicare.  You can get Medicare if you’re 65 or older or have a qualifying disability.

Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income.  There are 49 Medicare Advantage Plans in the state that are an alternative to Original Medicare.  Learn more about your Medicare options in New Jersey.

Medicare Plans in New Jersey

Compare ratings of New Jersey’s Medicare plan providers:
Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars 5 out of 10
Cigna 4 stars A- Not rated 2.5 to 4.5 stars Seventh out of 10
Humana 4 stars A- A+ 1.5 to 4.5 stars Third out of ten
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

Medicare Plan Options in New Jersey

Residents of New Jersey have multiple Medicare plans to choose from. Many are tiered to help New Jerseyns find the plan that is best suited to your lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. New Jersey’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.

Original Medicare (Parts A and B) Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:

  • Original Medicare is a good choice if you want flexibility in choosing and accessing providers that accept Medicare anywhere in the U.S.
  • There is no cap on what you could spend for out-of-pocket expenses, and you must purchase drug coverage separately, so it’s a better choice for you if you don’t need much in the way of health care or prescription drugs.
  • If you don’t purchase a Medigap policy to supplement Original Medicare when you are first eligible, you may not be able to purchase one or may have to pay higher premiums, depending on your health status.
Medicare Advantage Plans (Part C) Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:

  • Medicare Advantage is a good choice if you want to have all of your health care and drug benefits bundled together in one plan and if you don’t mind being restricted in your choice of providers to save on costs.
  • There is a cap on what you can spend for out-of-pocket Medicare-covered expenses.
  • You also have access to services that Medicare doesn’t cover, like routine dental and vision exams.
Medicare Prescription Drug Coverage Plans (Part D) Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:

  • Part D is a good choice if you have Original Medicare, or if you have a Medicare Advantage Plan ― not a health maintenance organization (HMO) or preferred provider organization (PPO) ― that doesn’t have prescription drug coverage.
  • You pay a penalty if you wait to enroll in a Part D plan, unless you have creditable coverage from an employer-sponsored group plan.
  • If you don’t require medications now, you can enroll in a low-premium Part D plan to avoid late enrollment penalties later.
Medicare Supplement Insurance Plans (Medigap) Some New Jersey seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.

  • Medigap is a good choice if you have Original Medicare and want help paying for out-of-pocket expenses you incur when you access your Part A and Part B benefits.
  • You pay a monthly premium, and most copays and coinsurance costs are covered.
  • If you have significant health care needs, want the freedom to see any Medicare provider without network restrictions, a Medigap plan offers predictable coverage and costs for Medicare-covered care.
  • Medigap doesn’t cover prescription drugs or other benefits like dental and vision.

Medicare in New Jersey by the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
1,104,816 Plan A: $0 to $499 per month*

Plan B: $170.10 per month**

$10,793 7.00%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in New Jersey

Getting support can help when you’re making Medicare decisions. New Jersey has numerous locations where enrollees can receive help through the State Health Insurance Program (SHIP). New Jersey SHIP has counselors throughout the state that work with local nonprofits and public health agencies, as well as Area Agencies on Aging (AAAs), to provide seniors with Medicare information.

New Jersey Medicare Information and Referral Service

The New Jersey Medicare Information and Referral Service provides seniors with free and unbiased counseling on Medicare and other insurance issues that cannot be addressed through SHIP. It also administers the Aging & Disability Resource Connection (ADRC) hotline, which connects seniors to their county office on aging to learn about and apply for senior services.

Contact information: Website | 1-800-792-8820

New Jersey Department of Health

The New Jersey Department of Health works to strengthen the state’s health system with the help of its five branches. Health Systems, Integrated Health, Office of Population Health, Office of Policy and Strategic Planning and Public Health Services. The Department of Health provides health care financing and licenses and evaluates state health care facilities The Health Care Quality Assessment office also provides reports to help seniors make more informed health care decisions.

Contact information: Website | (609) 292-7838

Area Agencies on Aging

There are 21 designated Area Agencies on Aging (AAA) in New Jersey, one in each of the state’s counties. These Agencies are responsible for developing community-based systems of services for older adults. They also act as lead agencies for the Aging & Disability Resrouce Connection (ADRC) in their area. The AAAs provide serve as advocates for the aging population and advise local governments and the Division of Aging Services on the unmet needs of the state’s seniors.

Contact information: Website | 877-222-3737

New Jersey Division on Aging

The New Jersey Division on Aging provides assistance to the 21 county areas on aging to help them develope care services for residents age 60 and over, including Medicare counseling. Available services include Mediare information and assistance, case management, homemaker, hospice, legal assistance, education, caregiver support, outreach, respite, telephone reassurance, transportation, visiting nurses and adult day care.

Contact information: Website |  1-800-792-8820

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