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Medicare Plans in New Jersey – Coverage and Benefits

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.

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.

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
  • Run 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

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.

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.

[chart category=”supplement” name=”planTypes” state=”NJ” zipcode=”07305″]

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. For more information on HMOs and PPOs in your area, read below.

[chart category=”advantage” name=”topHMOPlans” zipcode=”36101″ state=”AL”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”36101″ state=”AL”]

More Information on Medigap Supplement vs. Medicare Advantage

If you’re still unclear about the difference between Medicare Advantage and a Medigap supplement, don’t worry – you’re not alone. Millions of seniors just like you are asking themselves similar questions right now. To help provide you with answers, we’ve compiled this handy chart with responses to some of the most frequently asked questions for each plan:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

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.

[chart category=”general” name=”usefulContacts”]

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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