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Medicare in New Jersey

October 6, 2016

As a New Jersey Medicare beneficiary, it’s important for you to familiarize yourself with the various parts of Medicare to get a better understanding of what your health insurance benefits entail. In brief, New Jersey Medicare encompasses Original Medicare, Part A and Part B, as well as Medicare-approved private health insurance through Medicare Advantage (Medicare Part C), and prescription drug coverage under Medicare Part D. 

Original Medicare for New Jersey beneficiaries

Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) together form Original Medicare. Original Medicare is available to U.S. citizens and legal permanent residents of five continuous years age 65 or older, and certain people under 65 with qualifying disabilities. New Jersey Medicare beneficiaries are eligible to enroll in Original Medicare during the Initial Enrollment Period, which begins three months before a person turns 65, includes the individual’s birthday month, and ends three months after the birth month.

Medicare beneficiaries in New Jersey can also enroll in Medicare during the General Enrollment Period, which takes place every year from January 1 to March 31. However, if you miss your seven-month Initial Enrollment Period and enroll in Medicare at a later date, you will probably have to pay a late-enrollment penalty.

New Jersey Medicare beneficiaries, like those in other states, are generally eligible to enroll in premium-free Medicare Part A because they (or their spouses) paid a minimum of 10 years Medicare taxes while working. Those who are not eligible for premium-free Medicare Part A may be able to receive Part A coverage if they pay a premium.

Medicare Part A offers the following health coverage:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Home health services

Medicare Part B, also part of Original Medicare, offers medical insurance with a monthly premium. As a New Jersey Medicare Part B beneficiary, you’re eligible to receive benefits for services and supplies such as those listed below:

  • Doctors’ visits, including preventive care
  • Medicare-approved Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, and partial hospitalization)
  • Outpatient lab and radiology

Medicare plan options in New Jersey

New Jersey Medicare beneficiaries may receive their Medicare benefits through an alternative means, Medicare Advantage. Medicare Advantage (Part C) permits private insurance companies contracted with Medicare to offer Medicare plans within their service areas. These are called Medicare Advantage plans, and they provide at least the same coverage as Original Medicare Part A and Part B (with the exception of hospice care, which continues to be covered by Part A).  Many Medicare Advantage plans provide extra benefits, such as routine vision, dental care and hearing coverage.

If you’re a New Jersey Medicare beneficiary seeking Medicare health and prescription drug coverage through a single health plan, you can enroll in a Medicare Advantage Prescription Drug plan. But note that even if you enroll in a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you have to stay enrolled in Original Medicare and continue paying the Medicare Part B premium to keep your health insurance coverage

In New Jersey, as in other states, you can also sign up for separate prescription drug coverage through Medicare Part D, which is also offered by Medicare-approved private insurance companies. These stand-alone Medicare Part D Prescription Drug Plans are designed to work alongside other Medicare coverage that does not include prescription drug coverage—Original Medicare Part A and Part B or a Medicare Savings Account Plan, for example. Stand-alone Medicare Part D Prescription Drug Plans offered in New Jersey have different costs, depending on the extent of the coverage you select, but most plans require payment of a monthly premium, annual deductible, and copayment or coinsurance.

If you to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.  Keep in mind that Medigap only works with Original Medicare. You can’t use these plans to pay for Medicare Advantage costs.

As a New Jersey resident, you can choose from various Medicare Advantage plans, depending on the county in which you live. If you live in Newark, in Essex County, for example, you may have different Medicare plan offerings than someone living in Jersey City, in Hudson County. Therefore, you will want to customize your search for plans based on where you live, and which plan best meets your individual health and prescription coverage needs.

For more information about private Medicare insurance for New Jersey beneficiaries, please see:

New Jersey resources for Medicare beneficiaries

There are a number of resources designed to help New Jersey Medicare beneficiaries with Medicare-related issues and concerns. Here are some of the resources that may be helpful to you:

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