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Medicare in New Jersey


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Overview of Medicare in New Jersey

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:

  • Medicare Part A provides coverage for inpatient hospital, skilled nursing facility, home health care, and hospice care.
  • Medicare Part B provides coverage for outpatient physician services, office visits, X-rays and lab tests, as well as certain preventive medical services (such as vaccines).

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:

  • Have Medicare Part A and Medicare Part B.
  • Live in the Medicare Advantage plan’s service area.
  • Not have end-stage renal disease (with some exceptions).

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.

Medicare resources in New Jersey

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:

  • State Health Insurance Assistance Program (SHIP) – This program is part of a federal program created to provide information, educational resources, and personal counseling to New Jersey Medicare beneficiaries. Trained volunteer counselors are available to provide one-on-one assistance with Medicare and health coverage questions, while periodic seminars offer more information in a group setting. There is also plenty of information and a list of resources on the SHIP web page.
  • New Jersey State Pharmaceutical Assistance Programs – This program offers information about financial assistance for New Jersey Medicare beneficiaries that need help with prescription drug coverage costs. The program explains the basics of Medicare Part D prescription drug coverage and offers information on available statewide programs that help eligible residents pay for their prescription drugs.
  • Senior Medicare Patrol (SMP) New Jersey – SMP is a federal program administered on a statewide basis to protect New Jersey Medicare beneficiaries from fraud and claim errors. Volunteers work in the office to educate seniors on how to spot and report fraud, waste, and abuse.

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.

Medicare statistical trends in New Jersey

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 –

  • 1,568,884 New Jersey residents received Medicare coverage in 2018. Of that number, 369,886 people enrolled in Medicare Advantage plans and other health plans. Approximately 1.2 million individuals enrolled in Original Medicare, Part A and/or Part B.
  • In 2018, more than 1.1 million Medicare beneficiaries in New Jersey had Part D prescription drug coverage through either a Medicare Prescription Drug Plan (PDP) or from a Medicare Advantage plan that included prescription drug coverage in its benefits (MA-PD). Approximately 910,205 individuals enrolled in a stand-alone Medicare Prescription Drug Plan (PDP) to get their Part D prescription drug coverage.

In 2018 –

  • 100% of people with Medicare residing in New Jersey have access to a Medicare Advantage plan.
  • 46Medicare Advantage plans are available state-wide in New Jersey.
  • 22Medicare Prescription Drug Plans are available state-wide in New Jersey.
  • 84% of people with Medicare Part D have access to a plan with a lower premium than what they paid in 2017.
  • 24% of people with Medicare Part D are eligible to receive Extra Help (also called the Low-Income Subsidy, or LIS)
  • $19.70 is the lowest monthly premium for a Medicare Prescription Drug Plan (premiums may be lower for individuals who qualify for Extra Help or higher for individuals who pay a late-enrollment penalty).

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.

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