Speak with a Licensed Insurance Agent
Have questions? We can help!
Call to speak with a licensed insurance agent.
1- TTY 711Touch to Call
Over 1.5 million residents of New Jersey received Medicare coverage in 2018, according to the Centers for Medicare & Medicaid Services (CMS). As a Medicare beneficiary, you may have several options when it comes to your Medicare coverage in New Jersey. Some of those coverage choices may include:
Original Medicare (Part A and Part B) is the federal health-care program for seniors and certain individuals who qualify at any age by disability or by having certain health conditions, such as Lou Gehrig’s disease or end-stage renal disease. To be eligible for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years.
Original Medicare is made up of two parts, Part A and Part B:
If you’re current enrolled in Original Medicare in New Jersey, you may have noticed that you’re not covered for all costs. For example, prescription drugs coverage is limited to medications you receive during covered hospital or skilled nursing facility stays or certain medications you get in an outpatient setting, like a clinic or doctor’s office. For all other prescription drug coverage, you’ll need to join a Medicare Prescription Drug Plan.
In addition, Original Medicare doesn’t cover long-term nursing care at home or in an assisted living facility if personal care (that is, help with daily living tasks) is the primary care you need. You’ll also be responsible for paying out of pocket when it comes to routine vision or dental services, hearing aids, and dentures.
Original Medicare beneficiaries in New Jersey can get help with prescription drug costs through a Medicare Part D Prescription Drug Plan (PDP). This type of plan provides stand-alone coverage that works alongside Original Medicare, Part A and Part B. Medicare Prescription Drug Plans are offered through private insurance companies approved by Medicare.
Medigap (Medicare Supplement) insurance plans are also offered by private insurance companies and can help with certain out-of-pocket expenses not covered by Original Medicare.
As an alternative way to get your Original Medicare coverage, you can also get your Medicare Part A and Part B coverage through a Medicare Advantage plan in New Jersey. Also known as Medicare Part C, Medicare Advantage plans are offered by private insurance companies that are approved by Medicare and are required to cover at least the same level of benefits as Original Medicare (with the exception of hospice care). In addition, many Medicare Advantage plans also cover extra benefits beyond the federal program, which may include routine dental and vision care, hearing, wellness programs, or prescription drugs.
In contrast to Original Medicare, where prescription drug coverage is available through a separate plan, Medicare Part C gives beneficiaries the option to enroll in a Medicare Advantage plan that covers all their Medicare medical and prescription drug benefits through a single plan. These plans are also known as Medicare Advantage Prescription Drug plans.
One benefit of Medicare Advantage plans is that these plans are required to include an annual out-of-pocket spending limit. This limit varies from plan to plan, but once your out-of-pocket costs (including the plan deductible) reach this threshold, the Medicare Advantage plan covers 100% of covered medical expenses for the rest of the year. In contrast, Original Medicare doesn’t have a yearly out-of-pocket cap, meaning there’s no ceiling to the amount you could spend on health care in a given year.
To be eligible for Medicare Part C, you must:
Keep in mind that Medicare Advantage plans set their own costs. Some plans may offer premiums as low as $0, but even if your service area has a $0 premium Medicare Advantage plan available, you may still be responsible for other costs, such as deductibles, copayments, or coinsurance. You’ll also need to keep paying your Medicare Part B premium, regardless of whether your Medicare Advantage plan includes a premium. So keep in mind that just because some service areas have Medicare Advantage plans with premiums as low as $0 doesn’t mean that you won’t have any other costs with this type of plan.
Division of Aging Services: Part of the New Jersey Department of Human Services, this department was established to provide support services to seniors through a single portal. This office is responsible for administering state and federal funding for programs to benefit seniors. It also oversees a number of programs designed to assist New Jersey Medicare beneficiaries, including:
Princeton Senior Resource Center: The Princeton Resource Center was established as a non-profit organization in 1974 to provide a variety of resources and services to seniors living in the Princeton area. However, the information on Medicare benefits available on this website is applicable to any senior living in the state. The organization offers basic information, as well as specifics on Medicare Savings Programs (which help with out-of-pocket Medicare costs) and additional coverage options in the state. Contact information is provided for additional New Jersey Medicare resources, including State Health Insurance Assistance Program (SHIP), the Medicare Rights Center, and supplemental insurance options.
State of New Jersey Department of Health: This state department is also a valuable resource for Medicare beneficiaries, particularly those who are having difficulty affording their coverage. In addition to information on public assistance options, the website for this state department also provides basic information on Medicare plans in the state, as well as links to federal and state offices, such as the New Jersey Department of Human Services. New Jersey residents can also find health-care information on specific conditions and other types of available health-care assistance.
As you consider your Medicare coverage options in New Jersey, here are some trends and facts of interest regarding Medicare in the state.
In 2018 –
In 2018 –
Statistical data from the Centers for Medicare & Medicaid Services, “Medicare Enrollment Dashboard”; and “2018 MA Part D Landscape State-by-State Fact Sheet”.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.