Medicare Coverage in New Jersey

 

The Medicare program provides health insurance coverage to eligible U.S. citizens and permanent legal residents of at least five years who are age 65 or older, in New Jersey and nationwide. You may also qualify for Medicare if you’re under age 65 in certain situations.

According to a report from the Centers for Medicare & Medicaid Services*, there were 1,485,769 beneficiaries enrolled in Medicare in New Jersey in 2015. Of this total, there were 233,355        residents enrolled in Medicare Advantage plans. In 2015, 876,915 New Jersey residents received Medicare prescription drug coverage through stand-alone Part D Prescription Drug Plans (PDPs), while 183,598 beneficiaries in the state received coverage for both their medications and Original Medicare benefits through Medicare Advantage Prescription Drug plans.

Types of Medicare coverage

Original Medicare refers to Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You’re automatically enrolled into the program at age 65 if you’re already receiving Social Security Administration (SSA) or Railroad Retirement Board (RRB) retirement benefits. Enrollment is also automatic if you’ve been receiving SSA or certain RRB disability benefits for at least 24 months in a row, or if you have amyotrophic lateral sclerosis (also called Lou Gehrig’s disease – your Medicare benefits start the same month that you qualify for SSA or RRB benefits in this case).

There are many Medicare plan options beyond Original Medicare in New Jersey, although availability of specific plans depends on exactly where you live. These include Medicare Advantage plans, Medicare Advantage Prescription Drug plans, stand-alone Medicare Part D Prescription Drug Plans, and Medigap plans. Medicare plan types and individual plans may have different out-of-pocket costs, coverage of health services, and (in some cases) additional benefits.

Medicare Insurance Plan Type Description
Medicare Advantage plan A health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans provide all your Medicare Part A hospital and Part B medical benefits besides hospice care, which remains covered under Medicare Part A. Types of Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, and others.
Medicare Advantage Prescription Drug plan A Medicare Advantage plan that includes prescription drug coverage. With a Medicare Advantage Prescription Drug plan, it’s possible to get all your Medicare benefits in one plan. Note that with any type of Medicare Advantage plan, you need to pay your Medicare Part B premium every month, in addition to any premium the Medicare Advantage plan may charge.
Stand-alone Medicare Part D Prescription Drug Plan Prescription drug coverage offered by private insurance companies that contract with Medicare. This kind of plan is designed to work alongside your Original Medicare, Part A and Part B, coverage. Like Medicare Advantage Prescription Drug plans, stand-alone Medicare Prescription Drug Plans may vary in terms of out-of-pocket costs and which prescription drugs they cover. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
Medicare Supplement (Medigap) plan Medigap plans are also offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Original Medicare.

New Jersey State Health Insurance Assistance Program (SHIP)

Medicare beneficiaries, caregivers, and their families can consult New Jersey’s State Health Insurance Assistance Program (SHIP) for free help with questions regarding health insurance. This assistance program is offered at many locations across the state, and its goal is to educate beneficiaries on Medicare benefits and claims, long-term care, and supplemental policies. Counselors are trained volunteers who provide information on different health insurance options and how to deal with insurance claims. Volunteers are not affiliated with any specific insurance company or product, but provide unbiased information.

You can also get your questions answered by one of eHealth’s licensed insurance agents by calling the phone number below; or, to compare Medicare plans in your area right away, just enter your zip code in the form on this page.

*Statistical data from the Centers for Medicare & Medicaid Services, “On its 50th anniversary, more than 55 million Americans covered by Medicare” as of July 28, 2015.

To learn about Medicare plans you may be eligible for, you can:

  • Contact the Medicare plan directly.
  • Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
  • Contact a licensed insurance agency such as Medicare Consumer Guide’s parent company, eHealth.
    • Call eHealth's licensed insurance agents at 888-391-2659, TTY users 711. We are available Mon - Fri, 8am - 8pm ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
    • Or enter your zip code where requested on this page to see quote.

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