New Jersey Medicare Guide

Get personalized Medicare advice from a licensed New Jersey Medicare Advisor! Schedule a free consultation or give us a call at (888) 604-0055 to get started.

This New Jersey Medicare Guide will walk you through the basics of Medicare to help you make an informed decision about your healthcare coverage.

Use this table of contents to jump to specific sections:

A Snapshot of Medicare in New Jersey

There are 1.7 million New Jersey Medicare beneficiaries, making up 18% of the state’s population. Most people are on Medicare due to age, but about 11% of New Jersey residents are on Medicare due to disability. 14% of all New Jersey Medicare recipients also receive Medicaid benefits. When it comes to Original Medicare vs. Medicare Advantage, New Jersey Medicare beneficiaries lean more toward Original Medicare. 65% stay on Original Medicare and 35% choose to move to a Medicare Advantage plan.

New Jersey Medicare Eligibility and Enrollment Steps

All US citizens who meet one of the following requirements are eligible for Medicare:

You’re 65 or older
You have certain disabilities like ALS and End-Stage Kidney Disease

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

Most people become Medicare-eligible when they turn 65 and enroll in Medicare during their Initial Enrollment Period (IEP). Your IEP is a seven-month window that starts three months before the month you turn 65, includes your birth month, and extends until three months after it. In some cases people choose to enroll in Part B later because they’re still working and receiving employer insurance coverage. Do the math on premiums and out-of-pocket costs and make sure you’d be eligible for a Special Enrollment Period later on to save on premiums and late enrollment fees.

2. Compare additional coverage options

Once you’re enrolled in Original Medicare, there are a couple of supplemental Medicare insurance plans (Medigap and prescription drug plans) that you can add onto your Original Medicare. You could also switch to a Medicare Advantage plan that offers a bundled approach to Medicare. The Medicare coverage you choose is an important decision that should be made based on your unique health and financial situation, and we’ll explain the details of your options later on. If you have any questions about these options, please reach out to one of our licensed New Jersey Medicare Advisors. We’re happy to help!

3. Get the best value from Medicare

Maximize the value you get from Medicare by scheduling appointments for your preventive services, including annual wellness visits, screenings, and vaccines.You should also share your new prescription drug plan information with your pharmacy to ensure you get the best price.

Every year, Medicare’s Open Enrollment Period lasts from October 15 - December 7. This is the perfect time to review any Medicare Advantage or prescription drug plans you’re enrolled in to be sure you’re still getting the best value. These plans can change every year, and so can your healthcare needs! Speak with one of our Medicare Advisors to review your needs, changes made to your plan, and other options available. In some cases, shopping around can save people thousands of dollars!

New Jersey Medicare Advantage Plans

There are 82 Medicare Advantage plans in New Jersey. Plan pricing and availability varies by county. For example, Bergen County has 43 Medicare Advantage plans and Salem County has 37.

Medicare Advantage plans are required to provide at least the same coverage as Original Medicare, but they often include added coverage for prescription drugs as well as vision, hearing, and dental services. These plans also tend to offer ancillary benefits, like fitness perks, telehealth, meals, and transportation.

Many Medicare beneficiaries choose Medicare Advantage plans because they can get extra coverage and benefits, often for no, or a low, additional premium. In fact, most Medicare Advantage plans have $0 premiums (although you still need to pay your Part B premium).

More coverage for no additional cost sounds great, so what’s the catch? Medicare Advantage plans have their disadvantages, including:

Network limitations
Frequent preauthorization requirements
Higher out-of-pocket costs (compared Original Medicare + Medigap)

To hear about and compare pricing and benefits for Medicare Advantage plans available in your county, give us a call at (888) 604-0055 or schedule a free consultation with one of our licensed New Jersey Medicare Advisors.

New Jersey Medicare Supplement Plans

Medicare beneficiaries have access to ten different types of Medicare Supplement plans in New Jersey. Medicare Supplement plans can also be referred to as Medigap plans, and we'll use the two terms interchangeably. Each letter plan (e.g., all Plan Ns) has identical coverage, even though pricing may be different from one insurance carrier to another. Your pricing may also be different based on your age, gender, and smoking status.

Many New Jersey Medicare beneficiaries add a Medigap plan to their Medicare insurance to help cover the 20% of costs that Original Medicare doesn’t pay.

Compared to Medicare Advantage, Medigap plans have some key benefits:

You can see any doctor that accepts Medicare (about 90% of doctors nationwide)
You don’t need prior authorization for covered services
Your out-of-pocket costs are significantly reduced (sometimes almost eliminated)

The best time to enroll in a Medigap plan is during the first six months you have Medicare Part B coverage (your Medigap Open Enrollment Period). During this time, you’re able to enroll in any Medigap plan from any insurance company without being asked questions about your medical history. Outside of this time, unless you meet the criteria for a handful of other guaranteed issue periods, insurance companies can ask you questions about your health history and deny your application for a Medigap plan.

New Jersey Part D Plans

Original Medicare doesn’t provide prescription drug coverage. Most Medicare Advantage enrollees will receive Part D (prescription) coverage through their Medicare Advantage plans. Those who don’t or who choose to stay on Original Medicare can enroll in a Part D plan. There are 24 stand-alone Part D plans available in New Jersey, with an average monthly premium of $44.65 (the 4th highest average in the country).

If you don’t take any prescriptions when you first enroll in Medicare, we still recommend you enroll in a low-cost drug plan to avoid paying Part D enrollment penalties later on!

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed New Jersey Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in New Jersey

Healthcare expenses add up! Individuals with lower incomes and resources may be eligible for three government programs.

New Jersey Medicaid

Medicaid is a jointly run state and federal program intended to help those with low incomes and resources with their medical expenses. Each state runs its own Medicaid programs, and New Jersey calls its Medicaid agency NJ FamilyCare. Like most states, New Jersey has specific Medicaid programs for those who are aged, blind, or disabled (commonly called ABD Medicaid). You can learn about these various programs here. Like most other states, New Jersey also has Medicare Savings programs, specifically for Medicare beneficiaries.

New Jersey has three Medicare Savings Programs:

Qualified Medicare Beneficiary (QMB) Program
Specified Low-Income Medicare Beneficiary (SLMB) Program
Qualifying Individual (QI) Program

Learn more about these programs here.

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance. Generally, if you’re on Medicaid or a Medicare Savings Program, you’re eligible for Extra Help too.

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from New Jersey
New Jersey pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed New Jersey Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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