Medicare in New Jersey
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 Medicare and Medicare Advantage Part C 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 D 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
- Visit your local SSA office
- 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.
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: $274 a month
- You or your spouse worked fewer than 7.5 years: $499 a month
Deductible:
- $1,556 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:
- $170.10 monthly and up (income-based)
Deductible:
- $233 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 $480 in 2022
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.
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 1,497,150 people are enrolled in Medicare Part A and B in New Jersey. The total number of beneficiaries enrolled in Medicare Advantage Increased from 510,896 to 557,494 year over year. Medicare Advantage participation in New Jersey went from 34.80% to 37.24% 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.
Medicare
New Jersey
1,497,150 Beneficiaries with Part A & Part B
557,494 Medicare Advantage Beneficiaries
37.24% Meducare Advantage Participation Rate
56.69% Female
43.31% Male
76.80% Non-Hispanic White
8.36% African American
7.07% Hispanic
7.78% Other/Unknown
13.60% Eligible for Medicaid
1.04 Average HCC Score
$12,248.01 Actual Per Capita Costs
19.29% Hospital Readmission Rate
24.90% of Beneficiaries with an Emergency Department Visit
510,896 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
34.80% Meducare Advantage Participation Rate, Previous Year
See more +
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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 $12,248.01 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:
Nationwide Resources
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.
Medicare guide
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
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Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
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Medicare Beneficiary Guide
For those currently enrolled in Medicare
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Low Income and Medicare Guide
For individuals with a qualifying income status
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A Caregiver’s Guide
For individuals with a qualifying income status
