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.
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.
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.
- Call GoHealth. Our licensed insurance agents are well-versed in Medicare in New Jersey and can help you navigate the enrollment process.
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:
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.
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
- 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
- $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
- $148.50 monthly and up (income-based)
- $203 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare in NJ: Part D
- Income-based; varies by plan
- 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.
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. 
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.
State of New Jersey Department of Human Services Division of Aging Services (DoAS)
NJ Save: 1-800-792-9745https://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
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
1-800-962-1253 for medical questionshttps://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
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
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