New Jersey residents, like members of all other 49 states, are eligible to enroll in Medicare upon reaching the age of 65. Medicare is designed to provide retired senior citizens with affordable health care treatment. Once you enroll, you will start receiving benefits from Parts A and B of Original Medicare. Take a look at the chart below for detailed information on what sort of coverage and benefits Original Medicare offers.

Coverage and Benefits

There are some up-front costs and monthly premiums associated with Original Medicare. Part B has fees and deductibles which every Medicare beneficiary must pay – click here for more details on the exact prices and rates. Part A, however, might be free if you have a long enough employment history. Anything longer than 40 quarters (a total of 10 years), and Part A is free. If not, then you will likely be required to pay an annual deductible before you can receive any Part A medical benefits.

You will have the option to apply for Medicare when you turn 65. Once you successfully make it through the Open Enrollment Period, you will have access to Medicare Part A benefits and the choice of accepting Medicare Part B benefits. Your Medicare Part A benefits will help with end-of-life care as well as hospital and other emergency treatments. Part B benefits help reduce your medical expenses with preventative care, outpatient treatment, and covering certain medical supplies.

Of course, you have a few other choices when it comes to Medicare. The two biggest ones are Medicare Part C and Medicare Part D. Medicare Part D is a relatively new prescription drug coverage program offered by the federal government. But if you would like to purchase Part D benefits, you must also purchase Medicare Part B. If you would rather not have Medicare Part A, B, or D, you can choose Medicare Part C (Medicare Advantage). Medicare Part C replaces Medicare Parts A & B with identical coverage from a private company. It may also replace Medicare Part D coverage if you purchase extra coverage with your Medicare Part C plan.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Different Types of Medicare Plans in New Jersey

In total, there are 1,378,274 seniors enrolled in Original Medicare right now. Of those, 15% (or 206,741 seniors) have decided to supplement their Medicare benefits by switching to a Medicare Advantage plan. Another 341,520 (or 25%) are supplementing their current Medicare coverage with a Medigap supplement policy. Still, that leaves 60% of Medicare recipients within the state of New Jersey either relying upon an employer benefit program to supplement their coverage, or without any supplemental coverage at all to protect them from the coverage gaps in Original Medicare.

Naturally, you should be actively enrolled in Medicare Parts A & B before you start shopping around for a supplement. If you are not enrolled in Medicare yet, click the link provided to get the ball rolling on that process.

Should New Jersey Residents Worry About Supplementing Their Medicare Benefits?

Honestly, it depends. Regardless of your age or relative level of health, it can be a truly cost-effective investment in the long run. Medical emergencies can happen to you at any time, and the cost of care for emergency and chronic illness isn’t going down any time soon. Having supplemental coverage can protect you from the following expenses:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Did you know that living in close proximity to air pollution can create tens of thousands of dollars in extra healthcare costs during your golden years? That’s why it’s especially important for New Jersey retirees to get affordable coverage. If you don’t purchase enough, you will leave yourself open to paying these costs out-of-pocket.

Thankfully, there are resources for New Jersey residents 65 and older to help supplement their Medicare coverage. There are Medicare Supplement plans and also Medicare Advantage plans which serve a similar purpose. But the benefits these plans provide you vary in scope and price. One plan may be better for you than another depending on your personal circumstances.

The gaps in Medicare coverage make it necessary for almost every senior to search for a supplemental policy. These coverage gaps can get very expensive when it comes to hospital and hospice care. Some supplements may even help you keep your Original Medicare premium costs and coinsurance costs under control. But if you stick with Medicare Parts A & B by themselves, you won’t be protected. And it could literally cost you in the long run.

It’s a fairly simple choice. You can save a little money now on monthly premiums but leave your savings at risk, or you can look into affordable supplemental coverage today and protect yourself from disastrously high medical bills in the future.

So now that you’re aware that there are expensive gaps in Medicare coverage, the next step is to find a supplement which can protect you the best. Medicare Advantage is a very comprehensive plan, but it can also be very expensive under the wrong circumstances. A Medigap supplement is a smaller, more affordable option for seniors who plan on relying on Original Medicare for their coverage needs.

Medigap Supplement Insurance for New Jersey Residents

Medigap supplements aren’t just any form of supplemental Medicare coverage. They have been designed, by private insurers and the federal government, specifically to neutralize the potentially expensive gaps in Medicare coverage. The 10 available plans (which are outlined in the chart below) are identical across all 50 states. Therefore, prices and providers will be different depending on your area.

Medicare Advantage Plans in New Jersey

Medicare Advantage is a little more complicated than a Medigap supplement. For starters, it effectively replaces your federally-sponsored Medicare benefits. The good news, though, is that the coverage you replace it with is legally required to be “equal to or better than” Original Medicare. Some insurance companies use this as an opportunity to add extra benefits, like vision or dental, for a relatively low additional expense in order to attract customers.

But do yourself a favor and take a look into the provider networks of the companies offering Medicare Advantage in your area. This is particularly important with Medicare Advantage, because their networks are notoriously limited. The prices may be competitive, but if it means you will have to switch to an “in-network” doctor in order to get your medical care, will those savings be worth it in the long run?

Medicare Advantage plans will provide care for their beneficiaries in one of two ways: either through a Preferred Provider (PPO) or a Health Maintenance (HMO) Organization.

More Information on Medigap Supplement vs. Medicare Advantage

Choosing the supplement insurance plan which protects you the best for the most affordable rate can be quite a challenge. One supplement plan will allow you to keep getting your Medicare benefits from the federal government; the other one will replace your federal Medicare completely. The cost between these supplements can also vary widely depending on where you live and how much healthcare you need.

First, let’s talk about Medicare Supplement Insurance – AKA, Medigap. With a Medigap policy, you get to keep your Original Medicare Parts A & B benefits. You also have the option to purchase Part D prescription drug coverage in addition. There are 10 different plans to choose from, ranging from least to most comprehensive the farther you get down the alphabet. All the plans are standardized so that you know which benefits you’re getting no matter where you live. There is only one monthly premium to pay, and most seniors find these premiums to be highly affordable – especially with more comprehensive plans like Plan F or Plan G.

On the opposite side of the fence is Medicare Advantage. Some people also refer to these insurance policies as Medicare Part C. This is a little misleading, because Medicare Part C isn’t technically a part of Medicare – it is a replacement insurance policy offered by a private company. These policies start by offering identical benefits compared to Medicare Parts A & B. From there, you have the option to purchase extra coverage for those coverage gaps, prescription drug coverage, and even additions like vision, for example. The only problem is that the more coverage you purchase, the more you will have to pay for your monthly premiums and other expenses.

Medigap supplements have certain advantages like a broader network of doctors and hospitals to choose from. These plans are also smaller and simpler which can help make them more affordable for some seniors. Medicare Advantage, on the other hand, despite having a restrictive network of doctors and hospitals, could provide more coverage for seniors who need it. Just understand that this coverage may come at a price. And if you can’t pass their pre-approval process – or worse, if you become too sick to be cost-effective to insure – you could lose your coverage. You won’t have these problems with a Medigap policy.

If you’re still unsure about which plan is right for you, please let us help. We have customer service representatives standing by to answer your inquiries. Our knowledgeable staff can help you sort between these two plans in order to find an insurance policy which will keep you covered and protected. We can even help you find an affordable quote. Until then, we hope the FAQ below can answer some of your unresolved questions.

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? If you live in an area where healthcare costs are low, there’s a chance that the government could take care of a substantial part or all of your monthly premium. You will be quoted a low monthly premium that you must pay each month in order to maintain coverage. The plan you choose will determine how large or small this payment will be.
Will I still have to pay for Part B? Yes Yes
What will it cost me? Your Medicare Advantage plan will cost you the remainder of your monthly premium which the government doesn’t pay in addition to any co-pays, coinsurance, or other out-of-pocket costs outlined by your plan. In addition to your monthly premium, you will pay whatever out-of-pocket costs not taken care of by your Medigap policy; certain comprehensive plans, however, will take care of things like your medicare premiums or coinsurance costs.
What will the plan cover? Medicare Advantage starts out with identical benefits to those of Medicare Parts A & B. From there, you can choose to purchase gap coverage, prescription drugs, dental, or more. Medigap plans start by covering Medicare Part A gaps, while more comprehensive plans cover Part B gaps as well. There is no vision, dental, or prescription drug coverage.
Is it easy to budget my health care expenses? Budgeting on a Medicare Advantage plan can be complicated, especially if you aren’t in the best of health and require treatment more frequently. Budgeting is a breeze with a highly comprehensive Medigap plan; the less comprehensive your policy, however, the less predictable your expenses will be.
Is my plan guaranteed? Or can it be cancelled? Like most health insurance policies, your Medicare Advantage plan is not guaranteed. You may lose your coverage or have your plan cancelled by your provider at their discretion. Only two scenarios will result in you losing your Medigap coverage: failure to pay your premiums or financial ruin of the company. Otherwise, you cannot lose coverage.
Do I have to clear a pre-approval or pre-certification process? Many insurance companies do have a pre-certification process which you must pass in order to purchase a plan Qualifying for Medigap coverage is easy – all you have to do is qualify for Original Medicare. That’s it!
Am I limited to specific doctors or hospitals? Medicare Advantage networks tend to be highly restrictive; however, if you live in an area with many different choices of doctors and hospitals, you may still get quality care at an affordable cost. You are only limited by the number of providers in your area who accept Medicare. Because Medicare is so widely accepted, so is your Medigap insurance.
What type of plan is best for me? Younger seniors, healthier seniors, and seniors who live in large cities may have a better opportunity to save with Medicare Advantage. Older seniors, seniors with greater health care challenges, seniors who live in rural areas, and seniors who are mostly concerned with Original Medicare coverage gaps tend to save more money with Medigap insurance.

Helpful New Jersey Medicare Resources

Below is a helpful directory full of useful contact information. With it, you can get in touch with local experts in the Medicare and Medicare supplement coverage fields. With enough research and effort, you can get all the information you need in order to make a well-informed decision.

Important Medicare-Related Healthcare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.
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