Medicare in New Jersey
- Medicare in New Jersey can be complicated. Learn about the plans that are offered and how you can enroll.
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 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.
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.
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.
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.
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.
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.
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.