Compare Medicare Advantage plans and quote side-by-side to get the best rate here.
Getting ready to turn 65 in the Garden State? Understanding your health insurance options can feel overwhelming. Keep reading to get the details you need to know about Medicare in New Jersey.
The Best Medicare in New Jersey:
- Best Overall in NJ: UnitedHealthcare
- Most Affordable in NJ: Aetna
- Best for Special Needs Plans: Amerigroup Community Care
- Best for Additional Health Benefits: Clover Health
- Best for Provider Choice: Horizon BCBS of New Jersey
What is Medicare?
Medicare is a health insurance program run by the federal government. It’s funded partially by money from Social Security taxes. You probably paying this tax every time you get a paycheck.
You usually need to be age 65 or older to be eligible for Medicare. Certain younger people with disabilities and those with end-stage renal disease may also qualify. You’ll also need to be an American citizen or permanent resident.
What are Medicare Plans?
Medicare is divided into 4 parts that represent different types of plans. You can choose which parts you want when you become eligible for Medicare. You’ll need to consider your health conditions and budget as you choose different Medicare options.
Part A: Medicare Part A plans offer hospital coverage. There’s a good chance you won’t have a monthly premium or payment amount for Part A coverage if you’ve paid into Medicare through your taxes. Part A plans cover hospital stays, hospice care and certain skilled nursing care after hospitalization.
Part B: Medicare Part B is medical insurance. That means it helps cover the cost of doctor visits, diagnostic tests, medical equipment and ambulance services. The government sets monthly premium costs for Medicare Part B. You may have to pay slightly higher premiums as well if you have a high income.
Part C: Medicare Part C is also known as Medicare Advantage. Medicare Advantage plans are offered through private insurance companies. They combine coverage from Parts A and B to form a bundled health insurance plan. Many Medicare Advantage plans also offer Part D coverage. Some plans offer dental, vision and hearing benefits not offered by Part A or Part B Medicare. You still need to enroll in Medicare Part A and Part B to sign up for a Medicare Advantage plan.
Part D: Like Medicare Advantage plans, Part D plans are found through private insurance companies. Medicare Part D plans cover some of your prescription drugs.
What is Original Medicare?
Original Medicare is Part A and Part B. Your Medicare options are often to enroll in Medicare Part A and Part B through the government or choose a private Medicare Advantage plan that bundles the coverage of Part A and Part B.
You can visit any doctor in the country who accepts Medicare if you choose Original Medicare. There are limits to how much a doctor can charge for a service if you participate in Medicare.
Why Choose Medicare Advantage Over Original Medicare?
The main reason you might want a Medicare Advantage plan over Original Medicare is that many plans offer additional benefits. Original Medicare doesn’t cover routine dental, vision or hearing services. Many Medicare Advantage plans offer this coverage in addition to regular hospital and medical coverage. You can also find Medicare Advantage plans that provide you with benefits like fitness center memberships or other perks.
Medicare Advantage plans also give you Part D coverage and you’ll need to purchase a separate Part D plan. Medicare Advantage plans usually have an out-of-pocket maximum as well. Your out-of-pocket maximum is the total amount you’ll pay for covered services during a year. This amount doesn’t usually count premium payments.
Legalities of Medicare in New Jersey
The Medicare program is regulated by the Department of Health and Human Services (HSS). Within the HSS, the agency that runs Medicare is the Centers for Medicare and Medicaid Services (CMS). The agency releases regular reports on the costs of each part of Medicare.
Medicare is a government-regulated program. This gives you access to certain rights and protections under the laws governing Medicare. Some of the most important rights you have under Medicare include the ability to:
- Receive respectful service at all times.
- Be protected from any type of discrimination, such as discrimination against your race, national origin, age, disability, religion or sex.
- Get information about your health and health care options in a way that you understand from Medicare and health care providers.
- Have your questions about Medicare answered honestly and accurately through your provider or Medicare office.
- Participate in your treatment decisions.
- Receive information about any claims you file.
- File an appeal if you disagree with claim decisions.
- File complaints about the quality of your care or treatment.
Types of Medicare Advantage Plans
Medicare Advantage plans often give you access to additional coverage and benefits you wouldn’t get with an Original Medicare plan. However, you’ll also face some restrictions about where you can get care and the plans available to you.
Most Medicare Advantage plans are regional and require you to live within the boundaries of the plan. You can choose from 2 types of insurance coverage: health maintenance organizations (HMOs) or preferred provider organizations (PPOs).
Both types of health insurance plans use a provider network to help you get access to care. Your insurance company’s provider network is a group of doctors and health care facilities that contract with the insurance company. You can save on costs when you visit an in-network doctor.
HMO: You’ll usually need to choose a primary care provider from your provider network with an HMO plan. Your primary provider is a doctor or health care facility you choose to visit for all of your medical services. Your primary provider needs to make a referral if you need to see a specialist. Your insurance won’t cover the cost of the visit if you visit a doctor outside your network. You’ll pay the full amount out of pocket, except in cases of emergency.
PPO: PPO plans use a provider network like HMO plans, but you’re not tied to one doctor or health care facility. You can see any provider in the network, including specialists. Let’s say you go to a facility outside the network. You can expect to pay higher rates but you won’t need to pay for the whole visit out of pocket.
How to Sign Up for Medicare in NJ
There are several ways to enroll in Medicare once you’re about to turn 65 years old. Three months before your 65th birthday, your initial enrollment period begins. This period lasts for 7 months, from 3 months before your birthday, your birth month and then 3 months following your birth month.
It’s best to enroll as soon as you’re eligible. You may have to pay a penalty for late enrollment if you wait too long.
You can sign up for Medicare in New Jersey using a few simple steps:
- Decide between Original Medicare and Medicare Advantage.
- Choose whether you want Medicare supplemental insurance, also called Medigap. These private insurance policies help you cover medical costs not covered by Medicare or Social Security.
- If you choose a Medicare Advantage plan, find a plan and insurance company you like.
- Here are 4 options for enrolling in Medicare:
- Sign up online at Medicare.gov.
- Call Social Security at 1-800-772-1213.
- Contact N.J. State Health Assistance Program (SHIP) online or call 1-800-792-8820.
- Visit your nearest Social Security office to get started.
Average Cost of Medicare Advantage Plans in NJ
There are many Medicare Advantage plans that offer $0 per month premiums. However, you’ll still have to pay the monthly premium for Medicare Part B. Many low-premium plans feature high out-of-pocket costs for health care treatments.
Check out the chart below for a few examples of what a healthy adult could expect to pay for Medicare Advantage in New Jersey, courtesy of Medicare.gov.
It’s important to remember that these numbers are loose estimates of your yearly costs. Health conditions, your age and your location can affect how much you pay each year for medical services. To get the best Medicare Advantage plan, contact the insurance company for more information on benefits, costs and coverage.
Best Medicare Insurance Providers in New Jersey
Finding a Medicare Advantage plan doesn’t have to overwhelm you. Start your research today by looking at our top choices for Medicare Advantage insurance providers in New Jersey.
1. Best Overall in NJ: UnitedHealthcare
UnitedHealthcare is the largest health insurance provider in the country.
The company offers a large selection of Medicare Advantage plans in New Jersey. You’ll also get access to a large provider network.
Many UnitedHealthcare Medicare plans come with dental, vision and hearing benefits to help you round out your health care coverage.
2. Most Affordable in NJ: Aetna Medicare
Aetna Medicare gives you access to several $0 monthly premium plans in New Jersey. In addition to the $0 premium plans, Aetna plans come with plenty of benefits.
Some Aetna plans have higher premiums than other providers, but the estimated yearly out-of-pocket costs are lower, thanks to the great coverage Aetna Medicare Advantage plans offer.
3. Best for Special Needs Plans: Amerigroup Community Care
Special Needs Plans (SNP) are Medicare Advantage plans that cover specific services and treatments for certain disabilities and health issues. Amerigroup Community Care offers a handful of affordable SNP options in New Jersey.
In addition to $0 monthly premium plans, the company has low monthly premiums that come with some great benefits. For example, you have access to a 24/7 Nurse HelpLine to answer all of your health-related questions.
4. Best for Additional Health Benefits: Clover Health
Most of the plans from Clover Health include coverage for dental, hearing and vision. You may be able to get a plan that has no out-of-pocket costs for a routine dental, hearing or vision checkup exam.
One of the best benefits of a Clover Health plan, however, is in-home care visits from a Clover nurse. You can get checkups and routine tests from a nurse who will come to your home or anywhere you feel most comfortable.
5. Best for Provider Choice: Horizon BlueCross BlueShield of New Jersey
Horizon BlueCross BlueShield is rated among the best for provider networks in the 2019 J.D. Power Health Insurance Study for New Jersey.
This means you’ll have access to a large network of doctors — the company also ranked in the top tiers for cost, coverage and benefits.
Learn More About Medicare Options in NJ
As you approach 65, be sure to consider your range of health care options in New Jersey. Start researching plans today so you’re ready for your Medicare enrollment period.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.