Medicare Advantage plans are available throughout New Jersey as an alternative for those who have Parts A and B of Original Medicare .
Medicare Advantage plans substitute for Original Medicare, providing at least the same coverage as Parts A and B and often additional benefits.
Medicare Advantage plans offer the protection of an out-of-pocket maximum .
New Jersey residents seeking drug coverage can either switch to a Medicare Advantage plan with Part D coverage or add a standalone Part D plan to Original Medicare.
If you live in New Jersey and have Parts A and B of Original Medicare, you qualify for coverage from a Medicare Advantage plan in New Jersey. In 2024, 100% of people with Medicare in New Jersey had access to a Medicare Advantage plan.
While Original Medicare is administered by the federal government, Medicare Advantage provides an alternative from private insurance companies. Plans must offer at least the same coverage as Parts A and B, and many feature additional benefits, such as dental and vision care.
- Part A of Original Medicare, commonly referred to as hospital insurance, covers inpatient hospital stays.
- Part B of Original Medicare, commonly known as medical insurance, covers outpatient services like doctor visits and durable medical equipment.
The coverage area for a Medicare Advantage plan is different from the coverage area for Original Medicare. While Original Medicare is accepted by providers throughout the country, Medicare Advantage plans vary by ZIP code and feature local networks of providers.
Can I bundle multiple benefits into one plan?See My Options
Some Medicare Advantage plans in New Jersey help pay your Part B premium.
- The average monthly premium for a Medicare Advantage plan in New Jersey was $19.22.
- 100% of Medicare-eligible New Jerseyans had access to at least one Medicare Advantage plan with a $0 monthly premium.
While Original Medicare operates with a universal cost structure in terms of out-of-pocket costs like premiums, deductibles, coinsurance, and copayments, each Medicare Advantage plan in New Jersey has its own approach to costs. Still, with the help of a GoHealth licensed insurance agent, it’s possible to make an apples-to-apples comparison by getting assistance selecting the Medicare Advantage plan that’s right for you.
One thing that is universal about Medicare Advantage plans is the presence of an out-of-pocket maximum, a feature that tells you the most you’ll have to pay out of pocket over the benefit year. Original Medicare doesn’t offer the protection of an out-of-pocket maximum.
Want to enroll in Medicare Advantage in NJ?
The state of New Jersey had 96 Medicare Advantage plans in 2024. According to the Centers for Medicare and Medicaid Services (CMS), 15 of the plans offered reduced cost-sharing and other innovative benefits for people who receive Extra Help, also called low-income subsidies, or who live with chronic illnesses.
Your first chance to enroll in a Medicare Advantage plan aligns with when you first enroll in Medicare Part A and B. This is called your Initial Coverage Election Period (ICEP).
- If you enroll in Parts A and B of Original Medicare when you turn 65, you have the option at the same time to switch to a Medicare Advantage plan that replaces Original Medicare. This option extends to three months after the month you turn 65.
- If you don’t enroll in Parts A and B when you turn 65, then you’ll still get an ICEP once you do. Whatever date you will first be in both Parts A and B, the three months leading up to that date provide a window to switch to a Medicare Advantage plan that will take effect on the date you were set to have both Parts A and B for the first time.
Suppose you don’t enroll in both Parts A and B when you turn 65, and you don’t have the benefit of a Special Enrollment Period. In that case, your next chance to enroll in Part B (most people can enroll in Part A at any time ) is during the annual General Enrollment Period.
If you utilize this period, which runs from January 1 to March 31 each year, then you’ll be covered by both Parts A and B for the first time on July 1. Then, from April 1 to June 30, you’ll have an ICEP that allows you to switch to Medicare Advantage (with that same July 1 start date).
If you didn’t utilize an ICEP to enroll in Medicare Advantage, you still have the option to do so during the Annual Enrollment Period that runs from October 15 to December 7 each year.
Now that you know when you can enroll in Medicare Advantage, you need to know how.
One simple approach: Reach out to a GoHealth licensed insurance agent to check your eligibility and begin your enrollment.
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The large majority of Medicare Advantage plans in New Jersey offer prescription drug coverage. This is among the reasons why some people prefer Medicare Advantage: It often bundles Part A and B coverage with Part D drug coverage (among other services), while with Original Medicare you must add a standalone Part D plan if you want drug coverage.
For those who prefer Original Medicare, private insurance companies offer stand-alone Part D plans in New Jersey. A GoHealth licensed insurance agent can help you find the right drug coverage for you, whether it’s stand-alone or part of a Medicare Advantage plan.
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