Overview of Medicare in New Jersey
More than 1.5 million New Jersey residents received Medicare coverage in 2021, according to Centers for Medicare & Medicaid Services (CMS). As a Medicare insurance beneficiary, you may have several options regarding your Medicare coverage in New Jersey.
Some of these coverage options may include: the original Medicare insurance plan (Part A and Part B) is the federal health care program for seniors and certain individuals who are eligible at any age, disability or certain health problems, such as Lou Gehrig’s disease or terminal kidney disease. To be eligible for Medicare insurance, you must be a U.S. citizen or legal permanent resident for at least five consecutive years.
Original Medicare is made up of two parts, Part A and Part B:
- Medicare Part A covers inpatient patients, qualified nursing facilities, home health care and hospital care.
- Medicare Part B covers outpatient medical services, office visits, x-rays and laboratory tests, as well as certain preventive medical services (such as vaccines).
If you’re currently registered for Original Medicare in New Jersey, you may have noticed that you are not covered by all fees. For example, prescription drug coverage is limited to medications you receive during stays in a covered hospital or in qualified nursing facilities, or certain medications you receive on an outpatient basis, such as a clinic or a medical practice. For any other prescription drug coverage, you will need to enroll in a prescription drug plan. In addition, Original Medicare does not cover long-term nursing care at home or in a life-aid facility, if personal care (that is, help with daily tasks) is the primary care you need.
You will also be responsible for paying for your pocket when it comes to routine or dental vision services, hearing aids and dental aids. Original New Jersey Medicare beneficiaries can obtain assistance to cover prescription drug costs through Medicare Part D. Medicare Part D. This type of plan provides independent coverage that works in conjunction with Part A and Part B. originating sickness are offered through private insurance companies licensed by Medicare.
Medigap (Medicare Supplement) plans are also offered by private insurance companies and can help with certain expenses not covered by Original Medicare. As an alternative way to get your original Medicare insurance coverage, you can also get your Medicare insurance Part A and B coverage under a Medicare Advantage plan in New Jersey. Also known as Medicare Part C, Medicare Advantage plans are offered by private insurance companies registered under the Medicare plan that must cover at least the same level of benefits as Original Medicare (excluding hospital care).
In addition, many Advantage Medicare plans also cover additional benefits beyond the federal program, which may include routine dental and visual care, hearing, wellness programs, or prescription drugs. Unlike original Medicare, where prescription drug coverage is provided under a separate plan, Part C of the Medicare plan provides beneficiaries with the opportunity to enroll in a Medicare Advantage Plan that covers all their prescription drugs and medical benefits through a only diet. These plans are also known as Advantage Medicare prescription drug plans. One of the benefits of Advantage Medicare plans is that these plans must include an annual charge limit.
This limit varies from plan to plan, but once your expenses (including plan deductible) reach this threshold, Medicare Advantage covers 100% of the medical expenses covered for the remainder of the year. On the contrary, Original Medicare does not have an annual cap, which means there is no limit on the amount you could spend on health care in a given year
To be eligible for Medicare Part C, you must:
- Ask Part A of Medicare and Part B.
- Live in the Medicare Advantage Service Area.
- You do not have terminal kidney disease (with a few exceptions).
Keep in mind that Medicare Advantage plans set their own costs. Some plans may offer premiums as low as $0, but even if your area of service has a Medicare Premium Advantage plan of $0 available, you may be responsible for other costs, such as deductibles, copays or co-insurance. You will also need to continue to pay your Medicare Part B premium regardless of whether or not your Medicare Advantage plan includes a premium. Keep in mind that the fact that some service areas have Medicare Advantage plans with premiums as low as $0 does not mean that you will not have any other cost with this type of plan.
Medicare resources in New Jersey
Aging Services Division: Part of the New Jersey Department of Social Services, this department was established to provide support services to older persons through a single portal. This office is responsible for administering government and federal funds for programs for seniors. He also oversees a number of programs designed to assist New Jersey Medicare beneficiaries, including:
- State Medicare Insurance Assistance Program (SIP) — This program is part of a federal program created to provide information, educational resources and personal advice to New Jersey medicare beneficiaries. Trained volunteer counsellors are available to provide individual health care assistance and questions about health coverage, while regular seminars provide more information in the middle of a group. There is also a lot of information and a list of resources on the SHIP website.
- State of New Jersey Pharmaceutical Assistance Programs — This program provides information on the financial assistance provided to New Jersey medicare recipients who need assistance to cover prescription drug coverage costs The program explains the basic principles of prescription drug coverage in the Part D of medicare and provides information on available government programs that help eligible residents pay for prescription drugs.
- Senior Medicare Patrol (SMP) New Jersey — SMP is a state-run federal program to protect New Jersey Medicare beneficiaries from fraud and claim errors. Volunteers work in the office to educate seniors on how to detect and report fraud, waste and abuse.
Princeton Senior Resource Center: Princeton Resource Center was established as a non-profit organization in 1974 to provide a variety of resources and services to seniors living in the Princeton area. However, the information on Medicare insurance benefits available on this site applies to any elderly person living in the state. The organization provides basic information, details on health insurance savings programs (which help cover the direct costs of medicare), and additional coverage options in the state. Contact information is provided for additional resources from New Jersey Medicare, including the State Medicare Insurance Assistance Program (SHIP), Medicare Rights Center and Supplementary Insurance Options.
New Jersey State Department of Health: This Department of State is also a valuable resource for medicare beneficiaries, especially those who have difficulty providing coverage. In addition to information on government assistance options, this website of the State Department also provides basic information about Medicare insurance plans in the state, as well as links to federal and state offices, such as the New Jersey Department of Social Services. Residents of New Jersey may also find Medicare information about specific conditions and other types of health care available.
Medicare statistical trends in New Jersey
If you’re considering your Medicare coverage options in New Jersey, here are some interesting trends and facts about Medicare insurance in the state.
- 1,568,884 residents of New Jersey received health coverage in 2018. Of these, 369,886 people have registered for Medicare Advantage and other health plans. Approximately 1.2 million people enrolled in Part A and/or Part B.
- In 2018, more than 1.1 million New Jersey medicare beneficiaries benefited from Part D prescription drug coverage through a Medicare Medicare Medicare (PDP) plan or a Medicare Advantage plan that included a Prescription coverage drugs in their benefits (MA-DP). Approximately 910,205 people enrolled in a prescription drug plan (PDP) independent of the medicare plan (POP) to obtain their prescription drug coverage under Part D
In 2018 —
- 100% of people with medicare living in New Jersey have access to a Medicare Advantage Plan. 46 plans Medicare Advantage are available throughout the state of New Jersey. 22Prescription drug plans are available throughout the state of New Jersey.
- 84% of people with Part D of the health care plan have access to a plan that is less than they paid in 2017.
- 24% of those with Part D of the insurance plan -sickness eligible for additional assistance (also known as the Low Income Grant or DSL)
- $19.70 is the lowest monthly premium for a Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Plan (premiums may be lower for those eligible for additional assistance or more for persons paying a penalty in case of late registration).
Statistical data from the Centers for Medicare and Medicaid Services, “Medicare Enrollment Board” and “2018 MA Part D Landscape State by State Fact Sheet”.
This website and its content are for informational purposes only. Nothing on the site should ever be used as a substitute for professional medical advice. You should always consult your doctor about the diagnosis or treatment of a health problem, including decisions about the right medication for your condition, as well as before performing a specific exercise or eating routine. Product and service descriptions, if any, provided on these Medicare ABC insurance websites are not intended to constitute offers of sale or demand in connection with a product or service.
Not all products are available in all areas and are subject to applicable laws, rules and regulations. This information is not a complete description of the benefits. Contact the plan for more information. Limitations, co-payments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.