Finding Medicare Plans in New Jersey
New Jersey offers a variety of options for Medicare, but sorting through them all can be overwhelming. We don’t think it should be. We’ve provided a guide to help you navigate the many options to find the coverage that’s right for you.
What Is Medicare and What Does It Cover?
Medicare is a government-sponsored health insurance program that covers certain health care expenses. It’s available to people 65 or older and certain people under 65 with a qualifying disability or illness. Medicare doesn’t cover everything, and it isn’t intended to pay all of your medical bills. Medicare beneficiaries typically pay a portion of medical expenses through deductibles, coinsurance, and copayments.
To see what’s covered, let’s take look at the four parts of Medicare individually:
Original Medicare (Parts A and B)
Original Medicare is the government sponsored component of Medicare, which has two parts:
Part A (Hospital Insurance) covers inpatient services, like hospital care, hospice, skilled nursing facility care, and nursing home care (as long as custodial care isn’t the only care needed).
Part B (Medical Insurance) covers outpatient services and supplies, like mental health care, ambulance services, and durable medical equipment (blood sugar monitors, walkers, canes, etc). It also covers certain services that prevent or detect illnesses early, like flu shots, cardiovascular screenings, and diabetes screenings.
Original Medicare doesn’t cover everything. Services generally not covered by Original Medicare include:
- Long term care (custodial care)
- Most outpatient prescription drugs
- Hearing aids
- Eye exams and eyeglasses
- Most dental care and dentures
- Routine foot care
- Cosmetic surgery
For this reason, there is a variety of Medicare plans available through Medicare-approved private insurance companies for more comprehensive coverage.
Medicare Advantage Plans (Part C)
Medicare Advantage plans provide the same coverage as Original Medicare (Parts A and B), though hospice is still covered by Part A. These plans are available through private insurance companies, contracted with Medicare, and can include additional coverage like dental and vision. Some Medicare Advantage plans, called Medicare Advantage Prescription Drug (MAPD) plans, also include prescription drug coverage.
To be eligible for Medicare Advantage plans, you must first be enrolled in both Parts A and B of Original Medicare. Premiums can start at $0 and increase according to the level of coverage selected. In addition to the premium charged by the plan, you will also need to continue paying your Part B premium.
Medicare Prescription Drug Plans (Part D)
Medicare Prescription Drug plans work alongside Original Medicare (Parts A and B) to help keep prescription medications more affordable. Prescription drugs are generally not covered by Original Medicare nor Medigap plans. These Stand-alone Prescription Drug plans assign each drug a set copay/coinsurance. These drugs are organized in tiers, with the lowest tier having the lowest copay/coinsurance. Each plan provides a drug formulary, allowing you to check the tier(s) that your medications fall into. This allows you to select the plan with the best overall value for your prescription needs.
Medicare Supplement Plans (Medigap)
As mentioned earlier, Medicare beneficiaries are still responsible for paying a portion of their medical bills. This is where Medicare Supplement plans come in. These plans are available through private insurance companies and work alongside Parts A and B to cover certain costs, like copayments, coinsurance, and deductibles. If you plan to stick with Original Medicare, a Medigap plan can help reduce your out-of-pocket costs.
Am I Eligible for Medicare Plans in New Jersey?
To qualify for Medicare, you must be eligible for Social Security benefits. Most people first become eligible for Medicare when they turn 65 years old.
If you’re 65 or older, you may qualify for Medicare if:
- You are a citizen or permanent resident (having lived in the US for at least 5 years), and
- You or your spouse worked at a job that paid towards your Medicare through Social Security deductions for at least 10 years.
If you’re under 65, you may qualify for Medicare if you have:
- been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
- received Social Security Disability Insurance (SSDI) for at least 24 months
If you’re unsure about your eligibility or will be turning 65 within the next six months, we’re here to help. You can view local plans online or speak with a licensed insurance agent by calling the number above.
When Can I Enroll in A Medicare Plan?
Medicare Advantage and Prescription Drug Plans
Your Initial Enrollment Period (IEP) is your first opportunity to enroll in Medicare. This IEP is a seven-month period, starting three months before your 65th birthday month.
You can then make changes to your Medicare Advantage or Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period runs from October 15th to December 7th every year.
Key Fact: The General Enrollment Period provides another chance to enroll in Original Medicare, in case you missed your IEP. This period occurs each year from January 1st to March 31st. If you choose to enroll in a Medicare Advantage plan, you can do so from April 1st to June 30th every year.
Medicare Supplement Plans
If you want a Medigap plan, your first opportunity to enroll is during your Medigap Open Enrollment Period. This six month period begins the month you are both 65 or older and enrolled in Medicare Part B.
Important Note: If you enroll during this period, you are guaranteed the Medigap plan of your choice, even if you have a pre-existing condition. But if you miss this period, carriers may charge higher premiums or deny you coverage altogether.
Special Enrollment Periods
If you’ve recently experienced a qualifying life event, you may be eligible for a Special Enrollment Period. Special Enrollment Periods allow you to make changes to your Medicare coverage outside of the periods discussed above. Qualifying life events include moving outside of your plan’s coverage area, moving into or out of a care facility, and more. Our licensed insurance agents can help determine whether you qualify for a Special Enrollment Period.
How Do I Select a Medicare Plan?
We’ll help you sort through your many options to find the coverage that’s right for you. Give us a call to speak with a licensed insurance agent. You can also compare plans online by using our form below.