Call Us
Menu

Medicare in New Jersey

Here’s your exit for Medicare information in NJ, including costs and coverages

Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in New Jersey is health insurance for all Americans aged 65 and older. They must be U.S. citizens or legal residents. There are some cases when you may be eligible before 65.

  • New Jersey residents must choose between Original MedicareOriginal Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare Advantage Part CMedicare Advantage is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). when enrolling. Original Medicare’s Parts A and B cover hospital and medical services. Medicare Advantage is an alternative with Parts A and B that replace Original Medicare.

  • Part C often includes other services and Part DMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. prescription drug coverage.

 

Shopping for Medicare in New Jersey can feel a little like picking from a diner menu. There’s something for every taste, and you’ll probably find a favorite. But choosing between Medicare plans in New Jersey is a little more complicated than choosing between pasta, waffles and fish tacos.

So, how can you choose between all the Medicare plans in New Jersey? What’s the difference between Original Medicare and Medicare Advantage in New Jersey? What are Part D and Medigap, and how do they fit into Medicare? If you have questions like these, here is GoHealth’s guide to Medicare in The Garden State.

Who Is Eligible for Medicare in New Jersey?

To enroll in Medicare in New Jersey, you must be at least 65 years old, and a legal U.S. citizen or have been a legal resident for five years. There are occasions when you may be eligible before 65, including:

  • You’ve received disability-based Social Security benefits for 24 months
  • You’ve drawn retirement benefits for 24 months from the Railroad Retirement Board (RRB)
  • You have End Stage Renal Disease (ESRD)
  • You have Amyotrophic Lateral Sclerosis (ALS)

How Do I Get Medicare in NJ?

Are you approaching your Initial Enrollment Period (IEP)? There are several ways to sign up for Medicare in New Jersey through the Social Security Administration (SSA).

  • Apply online at the SSA website [1]
  • Visit your local SSA office [2]
  • Call SSA at 1-800-325-0778
  • If you worked for a railroad, you may have to apply through the Railroad Retirement Board (RRB). Give the RRB a call at 1-877-772-5772.
  • Call GoHealth. Our licensed insurance agents are well-versed in Medicare in New Jersey and can help you navigate the enrollment process.

 

What Is the Best Medicare Plan in NJ?

Finding the best Medicare in New Jersey comes down to your personal needs. To help assess which Medicare plans will fit you, here are the two main ways you can receive Medicare: Original Medicare (Parts A and B) and Medicare Advantage (Part C). Here’s an overview of how each works:

Original Medicare (Parts A & B)

  • Medicare Part A: provides hospital coverage
  • Medicare Part B: provides medical coverage

Enrollees often add Medicare Supplement Insurance (Medigap) and Prescription Drug Plan (Part D) to help control high out-of-pocket costs and provide medications.

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage. Private insurance companies offer Medicare Advantage in New Jersey. Unlike Original Medicare, Medicare Advantage often uses provider networks.

How Much Does Medicare Cost in NJ?

If you’re trying to budget for Medicare plans in New Jersey, you’ll want to start with a few standard costs. What you’ll ultimately pay, however, comes down to your medical needs and the plan (or plans) you choose. Here are the standard costs you can expect to pay for Medicare in New Jersey to give you a starting point.

Medicare in NJ: Part A

Premium:

  • Typically no-cost if you or your spouse worked 10 or more years
  • You or your spouse worked between 7.5 and 10 years: $259 a month
  • You or your spouse worked fewer than 7.5 years: $471 a month

Deductible:

  • $1,484 each plan period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in NJ: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in NJ: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

What Are the Different Plans of Medicare?

Medicare in New Jersey is four main parts:

Original Medicare (Parts A and B) enrollees can also enroll in Medicare Supplement Insurance (Medigap). Medigap can pay out-of-pocket costs associated with Original Medicare plans in New Jersey, such as premiums, copayments, and deductibles.

What Does Medicare Cover in NJ?

You are wondering if Medicare in New Jersey has your needs covered? Here are some of the benefits you can expect from the different parts of Medicare.

Medicare in NJ: Part A coverage

Provides hospital benefits, including:

  • Inpatient care
  • Skilled nursing facility care
  • Hospice care
  • Some home health care

Medicare in NJ: Part B coverage

Provides medically necessary and preventive services, including:

  • Treatment from doctors and other medical practitioners
  • Outpatient care
  • Some home health care
  • Durable medical equipment like wheelchairs

Medicare in NJ: Part D coverage

Provides prescription drug services:

  • Generic, brand-name, and specialty drugs
  • Commercially available vaccines (unless covered by Part B)

Medicare in NJ: Medicare Advantage (Part C) coverage

An alternative to Original Medicare (Parts A and B):

  • Replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare.
  • Many Medicare Advantage plans include Part D coverage
  • Often include vision, dental and hearing

Why Medicare Advantage Plans Are Bad?

Enrollment in Medicare Advantage in New Jersey tends to lag behind Original Medicare. But that doesn’t mean you should ignore Part C when deciding on a Medicare plan. While it may not be as popular, Medicare Advantage does provide valuable benefits to its recipients. If you’re choosing between Original Medicare and Medicare Advantage, here are the main characteristics to start with:

  • Original Medicare tends to have higher costs but offers more flexibility to see any doctor that accepts Medicare.
  • Medicare Advantage uses provider networks in exchange for lower out-of-pocket costs.

If you still have questions about Medicare Advantage in New Jersey and how it stacks up with Parts A and B, the licensed insurance agents at GoHealth will walk you through the pros and cons so you can make the choice that works for you.

What Are the Top 3 Medicare Advantage Plans?

If you’re trying to find the top Medicare Advantage plans in New Jersey, the answer comes down to your preferences and personal details. Medicare Advantage typically includes additional services, like vision, dental, hearing, and Part D. You should also know how to compare Medicare Advantage in New Jersey and how different plans affect your coverage.

The Four types of Medicare Advantage in New Jersey are:

  • Health Maintenance Organization (HMO): HMOs use primary care physicians that manage your care and refer you to other providers within your network.
  • Preferred Provider Organization (PPO): PPOs use primary care physicians but allow flexibility to see out-of-network providers
  • Private Fee-for-Service (PFFS): PFFS plans pay providers separately for each service they provide.
  • Special Needs Plans (SNP): There are two types of SNP plans: D-SNP and C-SNP. Dual eligible enrollees can qualify for D-SNP. Enrollees with certain chronic conditions can qualify for C-SNP. [3]

Medicare in New Jersey by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,444,602 people are enrolled in Medicare in New Jersey. The total number of beneficiaries enrolled in Medicare Advantage in New Jersey is 396,757. The previous year, 366,610 enrolled in Medicare Advantage. Medicare Advantage participation in New Jersey went from 25.77% to 27.46% year over year. If you’d like to dive deeper into how Medicare in New Jersey breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of New Jersey
1,444,602
Beneficiaries with Part A & Part B
396,757
Medicare Advantage Beneficiaries
27.46%
Medicare Advantage Participation Rate
56.91%
% Female
43.09%
% Male
1.05
Average HCC Score
$12,546.15
Actual Per Capita Costs
13.77%
% Eligible for Medicaid
30.22%
% of Beneficiaries with an Emergency Department Visit
18.76%
Hospital Readmission Rate
76.84%
% Non-Hispanic White
9.09%
% African American
7.19%
% Hispanic
6.88%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

New Jersey Medicare Resources & Contacts

Beneficiaries spend an average of $12,546.15 each year on Medicare in New Jersey. To be certain you are not leaving anything on the table, give us a call. A GoHealth licensed insurance agent can assess your coverage or explain which New Jersey-based resources, like these, may be able to help:

State of New Jersey Department of Human Services Division of Aging Services (DoAS)

General: 1-800-792-8820

NJ Save: 1-800-792-9745

https://www.state.nj.us/humanservices/doas/home/

What should I know about the New Jersey DoAS?

Apply for financial assistance to help pay for your Medicare premiums, prescription drugs, and more through NJ Save

State of New Jersey Department of Human Services Division of Medical Assistance & Health Services

1-800-356-1561

https://www.state.nj.us/humanservices/dmahs/clients/medicaid/

What should I know about the Division of Medical Assistance & Health Services?

Sign up for Medicaid or programs geared for seniors

New Jersey Department of Health

1-609-292-6683

1-800-962-1253 for medical questions

https://www.nj.gov/health/

What should I know about the New Jersey Department of Health?

Compare medical facilities, lodge a complaint and find local information

New Jersey Department of Military & Veterans Affairs

1-844-624-8387

Fax: 1-984-204-8343

https://www.milvets.nc.gov/contact-us

What should I know about the New Jersey Department of Military and Veterans Affairs?

NJ vets can get counseling and help with housing, education, and credit

Nationwide Resources

Speak with an insurance agent that is licensed in New Jersey about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in NJ, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

Previous Next

New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.