Understand Medicare in New Jersey
Medicare, the United States federal medical insurance program, provides coverage for nearly 1.7 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 $506per month in 2023. Part B costs $164.90 per month but can be more if you have higher income. There are 92 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|
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||J.D. Power ranking|
|Aetna||4 stars||A+||A+||6th out of 9|
|Cigna||4 stars||A-||Not rated||8th out of 9|
|Humana||4 stars||A-||A+||2nd out of 9|
|UnitedHealthcare||3.5 stars||A+||A-||4th out of 9|
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:
|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 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:
|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.
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|
|1,109,324||Part A: $0 to $506 per month*
Part B: $164.90 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
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