New Jersey Medicare Advantage Plans Provide Medical Coverage

Medicare, a government-run healthcare program, allows Garden State seniors to get coverage at 65. Basic coverage is known as Original Medicare. It includes Part A (hospital insurance) and Part B (outpatient insurance), but it doesn’t cover everything. You won’t have a cap on out-of-pocket expenses and prescription drugs aren’t covered.

Another option is Medicare Part C, or Medicare Advantage plans. These plans are provided by private insurance companies, but must provide the same basic coverage as Original Medicare. Most Medicare Advantage plans cover prescription drugs and limit out-of-pocket expenses for care.

What You Need to Know

Medicare Advantage plans offer the same basic coverage as Medicare Part A and B.

Many MA plans include coverage for prescription drugs.

You can’t sign up for a Medicare Advantage plan until you’ve enrolled in Original Medicare.

What Types of Medicare Advantage Plans Are Available?

Medicare Advantage plans generally contract with a network of doctors and medical facilities to limit the costs of your care. Types of plans include:

• Health Maintenance Organization (HMO): You’ll save money by using an in-network medical facility. If you go out-of-network, you could pay more out-of-pocket. Most plans require you to designate a primary care physician (PCP).
• Preferred Provider Organization (PPO): This plan lets you visit any provider, but you’ll likely pay less at an in-network facility. You probably won’t need to choose a PCP.
• Special Needs Plans (SNP): Plans designed for specific health conditions.¹
• Chronic Condition SNP (C-SNP): A plan for specific medical conditions, such as cancer or diabetes.
• Institutional SNP (I-SNP): You’re eligible for this plan if you live in an institution, such as a nursing home, or require in-home nursing care.
• Dual-Eligible SNP (D-SNP): These plans require you to be eligible for both Medicare and Medicaid.
• Private Fee-for-Service (PFFS): These plans decide how much to pay providers for care. They also determine how much you pay. You won’t need to designate a PCP.
• Medicare Medical Savings Accounts (MSA): This plan combines a high-deductible insurance plan with an MSA to help cover out-of-pocket expenses.

What Are Prescription Drug Options with Medicare Advantage?

Medicare Advantage plans often include coverage for prescription drugs. Original Medicare, on the other hand, requires a separate Medicare Part D plan for medications.

Check your MA plan’s drug formulary, or list of covered medications, to make sure your prescriptions are included. 

How Do You Choose Medicare Advantage Plans?

To choose a Medicare Advantage plan, compare the costs and coverage of available plans in your area.

Costs

• Deductible: The amount you’ll pay out-of-pocket per year before your plan’s benefits start paying for medical care.
• Coinsurance: The portion of a medical service you’ll need to pay out-of-pocket, usually a percentage of the total.
• Copay: A fixed price for specific medical services or procedures.
• Out-of-Pocket Maximum: The maximum you’ll pay out-of-pocket for services per year.

Plan Benefits

• Vision: Coverage for services like eye exams or frames.
• Dental: Coverage for dental services such as teeth cleaning or checkups.
• Telehealth: This coverage includes remote health services like video office visits or phone consultations.
• Additional Perks: Many MA plans offer coverage for transportation services or reimbursement for gym memberships.

When and How to Enroll in Medicare Advantage?

You can apply for a Medicare Advantage plan when you enroll in Medicare Part A and B. You’re first eligible from the three months before you turn 65 to the three months after you turn 65.

Miss your Initial Enrollment Period? You can enroll during the General Enrollment Period, from January 1 to March 31 each year. Be aware, you may have to pay late penalties on your Medicare premiums if you sign up after your Initial Enrollment Period. Sign up for Original Medicare online, over the phone or in person at a Social Security office.

You can apply for an MA plan once you’re enrolled in Original Medicare. There are several enrollment periods for MA plans:²

• Initial Enrollment Period: Sign up for an MA plan when you enroll in Original Medicare.
• Medicare Annual Election Period: Join a Medicare Advantage plan during the annual open enrollment from October 15 to December 7.
• Medicare Advantage Open Enrollment Period: You can change an existing MA plan or switch to Original Medicare each year from January 1 to March 31.
• Special Enrollment Period: You may be eligible to sign up for an MA plan outside of normal enrollment periods in certain situations, such as:
  • You’re moving out of your plan’s service area.
  • You’re getting coverage from an employer or union.
  • You’re losing your existing coverage, including becoming ineligible for Medicaid.
  • Your plan is leaving Medicare.
  • You’ve been diagnosed with a special condition and need an SNP.

How Much Do Medicare Advantage Plans Cost in New Jersey?

The cost of a Medicare Advantage plan varies, depending on your coverage needs and the type of plan you choose. Your location plays a large role as well. The average cost of a Medicare Advantage plan in New Jersey is $23.26 monthly.³

For example, if you sign up for an MA plan in Jersey City or Trenton, your monthly premiums could be between $0 and $104.⁴ Don’t forget to compare other costs, like deductibles and coinsurance, when comparing plans.

What If You Want to Change Your Medicare Advantage Plan?

Changing your Medicare Advantage plan is easiest during one of the open enrollment periods. You’re automatically disenrolled from your old MA plan when your new coverage begins.

What Are Alternatives to Medicare Advantage?

Medicare Advantage plans aren’t your only insurance option. Other coverage options include:

• Program of All-Inclusive Care for the Elderly (PACE):⁵ This program offers community-based medical services if you meet eligibility requirements.
• Original Medicare: Choose Medicare Part A and B if you don’t need additional coverage.
• Medicare Supplement: A supplemental insurance plan that helps with costs not covered by Original Medicare. It’s also called Medigap.
• Medicare Supplement with Part D: You’ll have to purchase a separate Medicare Part D plan for prescription drug coverage, because it’s not included in Medigap policies.

What Are Medicare Resources in New Jersey?

• State Health Insurance Assistance Program (SHIP):⁶ A free service offering unbiased advice to answer your Medicare questions and help you enroll in a plan.
• Medicaid:⁷ This federal program helps people with low income or disabilities pay for medical services.

State Medicare Advantage Data in New Jersey

Next Steps

Is a Medicare Advantage plan right for you? Start comparing plan options now so you’re ready to sign up when you enroll in Medicare Part A and B.