Medicare Plans in New Jersey

How Do I Enroll in Medicare in New Jersey?

To enroll in Original Medicare, do one of the following:

  • Submit an online application.
  • Apply in person at a Social Security office.
  • Call 800-772-1213 to speak with a Social Security employee.

What New Jersey Medicare Plans Are Available?

The two main types of Medicare plans are Original Medicare and Medicare Advantage. As of 2020, New Jersey had 1,117,597 residents enrolled in Original Medicare and 518,295 residents enrolled in Medicare Advantage, a total of 1,635,892 people.

Original Medicare

Original Medicare is broken up into two parts that cover different services. Medicare Part A covers inpatient care, such as the care received in a hospital or skilled-nursing facility, as well as home health care. Medicare Part B covers outpatient services, including doctor visits, preventive screenings and ambulance transportation. It also covers durable medical equipment, such as supplemental oxygen, blood glucose monitors and infusion pumps.

Medicare Advantage

While Original Medicare is administered by the Centers for Medicare & Medicaid Services, a federal government agency, Medicare Advantage is a type of Medicare plan offered by a private insurance company. To offer Medicare Advantage plans, also known as Medicare Part C plans, an insurance company must be approved by CMS. All Medicare Advantage plans must also provide at least the same amount of coverage offered by Original Medicare.

What makes Medicare Advantage plans so attractive to some enrollees is that they sometimes cover more services than Original Medicare; for example, some plans pay for routine dental care, which Original Medicare doesn't cover.

Medicare Advantage plans may be classified as health maintenance organizations (HMOs), preferred provider organizations (PPOs), special needs plans (SNPs) or private fee-for-service plans. Medicare Advantage plans are available in parts of all 50 states except for Alaska.

Medicare Part D

Medicare Part D is a supplemental plan designed to cover the cost of prescription drugs. Since New Jersey Medicare Advantage plans include prescription coverage, Medicare Part D is only available to beneficiaries enrolled in Original Medicare.

Enrollees pay a separate monthly premium for their Part D plans, and this premium varies based on the level of coverage provided and the amount of the annual deductible. Part D plans with low premiums typically have higher copays and deductibles than plans with higher premiums.

Medicare Supplement Insurance Plans (Medigap)

Medicare beneficiaries must pay deductibles, copays, coinsurance and other out-of-pocket costs. Many beneficiaries in New Jersey purchase Medicare Supplement Insurance, also known as Medigap, to cover these extra expenses.

Medigap plans are sold by private insurance companies and have a premium that depends on factors such as the enrollee's location and the amount of coverage provided. Any time a beneficiary incurs a medical expense, Medicare pays its share of the costs before the Medigap coverage kicks in.

Massachusetts, Minnesota and Wisconsin standardize their Medicare Supplement Insurance plans differently than New Jersey and the other 46 states.

Who Is Eligible for State Medicare?

If you're receiving benefits from the Social Security Administration or the U.S. Railroad Retirement Board at least four months before you turn 65, you should be enrolled automatically. If you aren't, you'll have a few opportunities to enroll in New Jersey Medicare coverage.

Initial Enrollment

When you first become eligible, you'll have an initial enrollment period in which to sign up for Medicare coverage. The IEP runs from three months before your birthday until three months after you turn 65, a total of seven months.

General Enrollment Period

If you don't sign up during your IEP, you'll have another opportunity to apply during the general enrollment period; however, you may have to pay a late enrollment penalty. The GEP runs from January 1 and March 31 of each year.

Special Enrollment Periods

Under certain circumstances, you may qualify for enrollment outside the IEP or GEP. For example, you may qualify for a special enrollment period if you lose another type of health coverage. Expatriates returning to the United States from another country may also qualify for a special enrollment period.

Open Enrollment Period

If you're not happy with your current Medicare plan, you can change it during open enrollment, which runs from October 15 to December 7 every year. During open enrollment, you can switch from Original Medicare to Medicare Advantage, switch from one Medicare Advantage plan to another or switch from Medicare Advantage back to Original Medicare.

How Do I Enroll in Medicare in New Jersey?

To enroll in Original Medicare (Part A and Part B), submit an online application at SSA.gov, call the Social Security Administration at 800-772-1213 or visit your local Social Security office. Before visiting your local SSA office, check the hours of operation to avoid having to go back another day.

Average Cost of Medicare Advantage Plans in New Jersey

Average Cost of Medicare Advantage Plans in New Jersey
Average Monthly Premium $57.45
Average in-network out-of-pocket spending limit $7,165.94
Average drug deductible in 2022 (weighted) $290.83
Percentage of plans rated 4 stars or higher 43.8%
Average Cost of Medicare Advantage Plans in New Jersey
Average Monthly Premium
$57.45
Average in-network out-of-pocket spending limit
$7,165.94
Average drug deductible in 2021 (weighted)
$290.83
Percentage of plans rated 4 stars or higher
43.8%

New Jersey Medicare Advantage Plans by County

The chart below provides more information about Medicare Advantage plan costs and enrollment in New Jersey by county in 2021.

Scroll to the right to continue reading the chart
County Average Premium Average Annual Drug Deductible % of Plans Rates 4 Stars or Higher # of Plans Available
Monmouth $65 $280 42.9% 42
Morris $67 $295 51.3% 39
Union $64 $285 42.9% 42
Hunterdon $61 $292 68.0% 25
Mercer $54 $295 44.7% 38
Middlesex $63 $268 22.2% 27
Somerset $54 $292 48.6% 35
Sussex $54 $292 48.6% 35
Ocean $54 $270 44.1% 34
Passaic $54 $284 37.8% 37
Salem $54 $329 42.9% 28
Atlantic $55 $302 43.6% 39
Bergen $54 $277 35.9% 39
Burlington $60 $299 48.5% 33
Camden $60 $299 48.5% 33
Cape May $56 $329 40.0% 25
Cumberland $56 $313 41.9% 31
Essex $54 $278 36.1% 36
Gloucester $59 $316 41.4% 29
Hudson $54 $273 33.3% 36
Warren $53 $290 62.1% 29

Contact Information for New Jersey Medicare, Medicaid and Insurance Help

If you have questions or need help understanding your Medicare options, take advantage of the following resources.

Medicaid

New Jersey Medicaid provides health coverage to New Jersey residents meeting certain income and other eligibility requirements.

New Jersey State Health Insurance Program

New Jersey SHIP has trained counselors on hand to answer questions about Medicare. The program is managed by the New Jersey Department of Human Services.

Phone: 800-792-8820

Website: https://www.state.nj.us/humanservices/doas/services/ship/index.html

Senior Gold Prescription Discount Program

If you don't have Medicare Part D, the Senior Gold Prescription Discount Program can help you save money on your prescription medications.

Website: http://www.state.nj.us/humanservices/doas/home/seniorgolddetail.html

Hearing Aid Assistance to the Aged and Disabled

HAAAD reimburses eligible individuals $100 for the purchase of hearing aids, which aren't covered by Original Medicare.

Website: http://www.state.nj.us/humanservices/doas/home/haaaddetail.html