Over the past decade, Medicare Part C enrollment has nearly doubled. More commonly known as Medicare Advantage (MA), more than 30 million Medicare beneficiaries had an MA plan in 2023. On this page, we describe Medicare Advantage plans in New Jersey and what to look for when comparing your options.
What is Medicare Advantage in New Jersey?
Every Medicare Advantage plan must provide the same benefits that you get with Original Medicare. This includes:
- Medicare Part A: Covers inpatient services that you'd receive in a hospital or skilled nursing facility (SNF)
- Medicare Part B: Covers outpatient services, such as doctor visits, lab work, outpatient procedures performed in a hospital, and durable medical equipment (DME
Original Medicare does not include prescription drug coverage.
Medicare Advantage plans are not limited to the benefits provided by Parts A and B. In fact, over 90% of them offer additional coverage. The most common items are:
- Fitness programs like SilverSneakers
- Prescription drug coverage
- Routine vision and dental care
Please note that joining a New Jersey Medicare Advantage plan does not exempt you from the Medicare Part B premium.
New Jersey Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Medicare Parts A, B, and D benefits into a single plan.
If you choose an MA plan that does not cover prescriptions AND you do not have creditable coverage elsewhere, you'll need to join a standalone Medicare Part D plan. (Creditable means a plan that is comparable to Medicare.) If you fail to maintain creditable drug coverage, you'll have to pay the Medicare Part D late enrollment penalty for the entire time you have Part D (once you join a plan).
Who is eligible for Medicare Advantage in New Jersey?
You become eligible for Medicare Advantage in New Jersey once you sign up for Medicare Parts A and B.
If you are an American citizen or permanent legal resident aged 65 or older, you qualify for Medicare. Enrollment in Parts A and B is automatic if you begin collecting Social Security benefits at least 4 months before your 65th birthday. Otherwise, you need to apply for Medicare.
Collecting Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months also qualifies you for Medicare, even if you aren't yet 65. Enrollment occurs automatically during month 25.
When can you sign up for a Medicare Advantage Plan in New Jersey?
You're first able to join a Medicare Advantage during your Initial Enrollment Period (IEP). It lasts for 7 months and starts 3 months before your Medicare eligibility month. For example, if your 65th birthday or 25th month of collecting disability benefits occurs in June, your IEP runs from March 1 through September 30.
The General Enrollment Period runs from January 1 until March 31 and is for anyone who did not sign up for Medicare Part A and/or Part B during their IEP. After General Enrollment ends, you can join an Advantage plan between April 1 and June 30.
You can also sign up for a Part C plan during the Medicare Annual Enrollment Period (AEP) that occurs every year from October 15 until December 7.
From January 1 through March 31, the Medicare Advantage Open Enrollment Period lets people who already have a Part C plan switch to a different one. You may also choose to return to Original Medicare. If that change causes you to lose your prescription drug coverage, you may also join a standalone Medicare Part D plan during Open Enrollment.
You may be eligible for a Special Enrollment Period (SEP) if you experience certain life changes. There are dozens of ways to qualify. Find the full list of special circumstances Medicare.gov.
Types of Medicare Advantages plans in New Jersey
There are four common types of Medicare Advantage plans in New Jersey.
Health maintenance organizations account for over half of all MA plans. HMO plans help control costs with provider networks. Most HMO plans will not cover non-emergency care received from an out-of-network provider. If you join an HMO plan, you'll also need to choose a primary care doctor and get a referral to visit a specialist.
Preferred provider organizations (PPO) also use provider networks. But PPO plans allow members to get out-of-network services for a higher copay. You also don't have to choose a primary doctor or get a referral to see a specialist with a PPO plan.
Private fee-for-service (PFFS) plans set price points for all covered services. Most use a provider network but are like PPOs in that they allow members to receive out-of-network care for a higher price. They also don't require enrollees to have a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) limit membership to people in one of the following populations:
- Have a chronic condition, such as diabetes, chronic heart failure, HIV/AIDS, dementia, or ESRD
- Live in an institution, such as a nursing home, or require at-home care
- Are dual eligible, meaning they qualify for both Medicare and Medicaid
Plan benefits are tailored to the specific population the SNP serves.
How to choose a Medicare Advantage plan in New Jersey
To get the best Medicare Advantage plan for your unique needs and budget, consider the following:
- Costs: May include an annual deductible, monthly premium, and copays or coinsurance payable for covered services.
- Coverage: Benefits vary, so look closely at coverage to understand what that monthly premium gets you. If it's an MA-PD plan, don't forget to review the drug formulary.
- Network: Any entity that provides healthcare services – doctors, labs, hospitals, etc. – may be included in the plan's network.
- Ratings: Medicare publishes its Advantage plan ratings each year in time for Annual Enrollment.
Our Find a Plan tool makes comparing Medicare Advantage plans in New Jersey easy. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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