Medicare in New Jersey

Resources for New Jersey Medicare Beneficiaries 

Medicare has multiple types of programs to choose from in addition to the varying enrollment periods. Once you understand your Medicare program options, then comes choosing a plan and the application process. Healthpilot is here to help.  

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

Medicare decision-making can be challenging, so support is useful. You can benefit from a lot of resources as a resident of New Jersey, such as the State Health Insurance Program (SHIP). In order to share Medicare knowledge and provide guidance, SHIP employs advisers all around New Jersey who work with local nonprofits, public health agencies, and Area Agencies on Aging (AAAs). 

Medicare Plan Options in New Jersey  

In New Jersey, you have more than one choice when it comes to having a Medicare plan. People who are eligible for Medicare and are 65+, or have a qualifying disability, can get Original Medicare. If you need more coverage, a Medicare Advantage plan, which is available in the Garden State, may be a better choice. You may also want to think about plans for prescription drugs and/or Medicare Supplement Insurance. 

Original Medicare (Parts A & B)  

Original Medicare is often referred to as “Basic Medicare.” It is divided into two parts: Medicare Part A, which covers hospital insurance, and Medicare Part B, which covers medical insurance. Parts A and B of Medicare have different deductibles that apply to different services. Part A, for example, has an inpatient hospital deductible per benefit period (every time you are admitted), whereas Part B has an annual deductible before Original Medicare kicks in for payment.  

Other things to consider if you want to keep Original Medicare: 

• Original Medicare in New Jersey is an excellent choice if you want the freedom to choose and access Medicare-accepting providers anywhere in the United States. 
• There are no networks, copays, waiting periods, or restrictions based on pre-existing conditions. 

Medicare Advantage (Part C)  

Commercial insurance companies offer Medicare Advantage plans, often referred to as Part C, as an alternative to Original Medicare. These plans provide at least the same coverage as Medicare Parts A and B would, and the most significant thing is that they frequently include additional benefits. Working similarly to how a Health Maintenance Organization (HMO) does, this arrangement places the onus of providing care on a network of providers. It often necessitates the involvement of a Primary Care Physician (PCP), the acquisition of a referral to see a specialist, and, in some cases, obtaining prior approval for services, treatments, and medications. Some of the other insurance plan type options include a Private Fee for Service (PFFS) plan, a Preferred Provider Organization (PPO), or a mix of an HMO and PPO called a Health Maintenance Organization-Point of Service (HMO-POS). 

Visit our Medicare Resource Page for Part C to find out more about Medicare Advantage. 

Medicare Prescription Drug Plan (Part D)  

Numerous Medicare Advantage plans offer Medicare Part D prescription medication coverage automatically. Additionally, you can add a stand-alone Prescription Drug Plan (PDP) to your Original Medicare or a Medicare Supplement Insurance policy. Depending on the selected plan, each covered prescription may be subject to a deductible, copayment, or coinsurance. 

Medicare Supplement Insurance (Medigap)  

Some Medicare recipients in New Jersey purchase Medigap, often known as Medicare Supplement Insurance. These plans were designed to help fill the coverage gaps left by Original Medicare. Medicare Part A and P deductibles, coinsurance, and coverage for medical care outside of the U.S. are a few of these gaps that are covered with a Medigap policy. You should be aware, however, that Medigap does not provide any coverage with Medicare Advantage. A Medigap plan and a Medicare Advantage Plan cannot be held concurrently. If you have a Medicare Advantage plan and want to buy a Medigap plan, the date your Medigap plan starts should begin the day after the date your Medicare Advantage plan ends to maintain continuous coverage.  

Since Original Medicare does not pay for all your medical payments, the New Jersey Department of Banking and Insurance (NJDOBI) provides guidance on how Medicare Supplement Insurance coverage might fill in the gaps. 

Medicaid 

Medicaid has existed as a public insurance program since 1965. Both the state and federal governments contribute funding. According to federal regulations, each state administers its own Medicaid program. The federal regulations are extremely broad, so states have a great deal of freedom to create and administer their own programs. Consequently, Medicaid eligibility and benefits can (and sometimes do) vary substantially between states. Medicaid assists eligible low-income individuals in obtaining health care, including children, parents, pregnant women, the elderly, and individuals with impairments. 

How and when to sign up for Medicare in New Jersey

Medicare is a government-run insurance program that is paid for by the federal government if you are eligible. At the age of 65, the vast majority of Americans can sign up for Medicare. The other qualifiers for Medicare eligibility include: 

• You are permanently disabled, under 65, and have been receiving Social Security disability benefits for at least 24 months. 
• You have been diagnosed with End-Stage Renal Disease (ESRD). 
• You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.  

Medicare Advantage Enrollment Periods in New Jersey and nationwide  

Here is a quick overview of the Medicare enrollment periods in which you can elect or change your Medicare Advantage plan.

New Jersey, fuggedaboutit! Healthpilot knows that navigating Medicare can be stressful, and adding enrollment timelines makes it even more tricky.  

Want to know the best news you’ll hear all day? We’ll do the dirty work for you. We’ll offer you the right recommended plan for your unique needs where you can enroll online in minutes. 

Once a Healthpilot customer, we do this for life. No need to memorize enrollment periods when you have Healthpilot on your side. 

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Key Stats

Some interesting facts about Medicare coverage in New Jersey:   

• There are 1,637,118 people in New Jersey who are on Medicare. This means that 18% of people have Medicare, just below the average of 19% for the whole country. 
• About 37% of Medicare customers in New Jersey are enrolled in a private Medicare Advantage program, which is less than the national average of 45%. 
• In New Jersey, the average monthly premium for a Medicare Advantage plan will go from $17.25 in 2022 to $14.98 in 2023. This means that the average premium has gone down by 13.2%. 
• 24 stand-alone Medicare prescription drug plans are available in 2023, meaning that Medicare prescription drug plans will be available to everyone in New Jersey who is eligible. 
• And as promised, here’s a fun fact about New Jersey: Nellie Bly was the first person to travel around the world in 80 days. She traveled from Hoboken and then arrived back in Jersey City. 

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