Medicare Plan Options
While Original Medicare provides the same basic health insurance coverage to everyone, there are ways to customize your coverage to make it cover more extensive medical needs. If you want to avoid paying high prescription drug costs out of pocket, you can add prescription drug coverage to your policy. To cut down on deductibles and other cost-sharing responsibilities, you may choose a Medigap plan. New Jersey’s Medicare Advantage program is also an option for obtaining more comprehensive coverage.
The Original Medicare program is managed by the federal government and offers basic coverage for hospital and medical services. It’s a fee-for-service program, which means that your health care providers are paid a predetermined fee for each service they provide. Original Medicare is made up of Part A coverage, which pays for expenses, such as inpatient care in a hospital, and Part B, which covers medically necessary services and preventative care. You don’t have to choose a primary care doctor, and you can usually set up a visit with a specialist without getting a referral. While this coverage is suitable for those with basic health needs, its limited scope of coverage may not be ideal for those managing chronic conditions. You generally have to pay a deductible before your coverage kicks in, and there’s no yearly out-of-pocket maximum.
Medicare Advantage Plans
Medicare Advantage Plans are provided by Medicare-approved private health insurance companies and typically provide comparatively robust coverage. These plans are available to those who qualify for both parts of Original Medicare and cover all the same benefits. Medicare Advantage Plans are a popular choice for those who want more robust coverage because these plans also generally include benefits, such as prescription drug coverage, vision and dental coverage, and discounts on fitness programs and memberships. There are over 20 Medicare Advantage Plans available in New Jersey, each with its own rules about medical deductibles, monthly premiums, and provider networks.
Medicare Prescription Drug Coverage Plans
Prescription drug coverage, or Part D, is an optional coverage that isn’t automatically covered under Original Medicare. Even if you don’t rely on prescription drugs when you sign up for Medicare for the first time, you may want to add this coverage to your policy to avoid late enrollment fees later on. These plans cover the bulk of prescription drug costs, but you still have some out-of-pocket expenses, such as monthly premiums, annual deductibles, and copay or coinsurance. Each plan has its own formulary, or list of medications that it covers, and uses tier pricing to determine what the plan pays and what you pay for a given medication.
Medicare Supplement Insurance Plans
Similar to Medicare Advantage Plans, Medicare Supplement Insurance Plans are sold by private companies. However, instead of adding benefits to your coverage, they make your Original Medicare benefits easier to afford by reducing copays, coinsurance, and deductibles. If you became eligible for Medicare prior to 2020, you may be able to sign up for a Medigap plan that reduces the Part B deductible. New plans sold after January 1, 2020, only cover the Part A deductible. You can only purchase a Medigap policy if you have Original Medicare. If you have Medicare Advantage, it’s illegal for a company to sell you a Medigap plan.
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 $471 per month*
Plan B: $148.50 per month**
*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
New Jersey has some helpful programs and resources that can take the guesswork out of signing up for a Medicare policy that fits your health needs. The state sponsors a program that provides you with free, unbiased counseling to help you make informed decisions about your health insurance. Some programs can help you find more information and recognize and report Medicare fraud and abuse.
State Health Insurance Assistance Program
SHIP is a statewide volunteer-driven program that provides you with objective information about your Medicare options. Its counselors aren’t affiliated with any health insurance companies and can’t sell you a Medigap or Medicare Advantage Plan. Still, they can help you evaluate your current and future health care needs, budget, and available options to make informed decisions about your coverage. Services are free and provided in one-on-one and group settings.
Contact Information: Website | 800-792-8820
Department of Banking & Insurance | Division of Insurance
The state’s Division of Insurance licenses and monitors state-regulated health insurance plans and advocates on behalf of consumers, ensuring they receive fair service. Through this division, you can get more information about Medicare programs offered by private insurance companies. You can also file complaints regarding issues, such as denied coverage or canceled policies.
Contact Information: Website | 800-446-7467
Senior Medicare Patrol NJ
New Jersey’s SMP promotes awareness of Medicare fraud, abuse, and waste through initiatives, such as community presentations, press events, and health fairs. Through this program, you can get helpful information about recognizing scams and signs of fraud or abuse on your medical bills. Agents can also provide referrals to health care agencies or local law enforcement for suspected cases of fraud or abuse.
Contact Information: Website | 877-767-4359
Passaic County Department of Senior Services, Disabilities, and Veterans’ Affairs
The Passaic County Department of Senior Services, Disabilities, and Veterans’ Affairs serves seniors in the most populous region of New Jersey and is one of 21 Area Agencies on Aging in the state. Through this agency, you can get in touch with SHIP counselors who can provide helpful information on your Medicare options and important deadlines. To find contact information for your county’s AAA, follow this link.
Contact Information: Website | 973-569-4060
Learn More from Our Sources
- Medicare | How Original Medicare Works
- Medicare | What Part A Covers
- Medicare | What Part B Covers
- Medicare | How Do Medicare Advantage Plans Work?
- Medicare | What Medicare Part D Drug Plans Cover
- Medicare | Part D Late Enrollment Penalty
- Medicare | Costs for Medicare Drug Coverage
- Medicare | What’s Medicare Supplement Insurance (Medigap)?