Medicare in New Jersey
Key Takeaways
- Medicare is health insurance for all Americans aged 65 and older. They must be U.S. citizens or legal residents. There are some cases when you may be eligible before 65.
- New Jersey residents can choose between Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). . Original Medicare’s Parts A and B cover hospital and medical services. Medicare Advantage is an alternative that substitutes for Original Medicare.
- Part C usually includes other services and Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. prescription drug coverage.
Shopping for Medicare in New Jersey can feel a little like picking from a diner menu. There’s something for every taste, and you’ll probably find a favorite. But choosing between Medicare plans in New Jersey is a little more complicated than choosing between pasta, waffles and fish tacos.
So, how can you choose between all the Medicare plans in New Jersey? What’s the difference between Original Medicare and Medicare Advantage? What are Part D and Medigap, and how do they fit into Medicare? If you have questions like these, here is GoHealth’s guide to Medicare in the Garden State.
Who Is Eligible for Medicare in New Jersey?
To enroll in Medicare in New Jersey, you must be at least 65 years old, and a U.S. citizen or a legal resident for at least five years. There are occasions when you may be eligible before 65, including:
- You’ve received disability-based Social Security benefits for 24 months.
- You’ve drawn retirement benefits for 24 months from the Railroad Retirement Board (RRB).
- You have end-stage renal disease (ESRD).
- You have amyotrophic lateral sclerosis (ALS).
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How Do I Get Medicare in NJ?
Are you approaching your Initial Enrollment Period (IEP)? There are several ways to sign up for Medicare in New Jersey through the Social Security Administration (SSA).
- Apply online at the SSA website
- Visit your local SSA office
- Call SSA at 1-800-325-0778
- If you worked for a railroad, you may have to apply through the Railroad Retirement Board (RRB). Give the RRB a call at 1-877-772-5772.
What Is the Best Medicare Plan in NJ?
Finding the best Medicare in New Jersey comes down to your personal needs. Start by assessing whether Original Medicare (Parts A and B) or Medicare Advantage (Part C) is the better fit for you. Here’s an overview of how each works:
Original Medicare (Parts A & B)
- Medicare Part A: Provides hospital coverage
- Medicare Part B: Provides medical coverage
Medicare Advantage (Part C)
Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B), offering the same Part A and B benefits. Medicare Part C usually bundles additional services like dental, hearing, vision, and prescription drug coverage. Private insurance companies offer Medicare Advantage in New Jersey. Unlike Original Medicare, Medicare Advantage often uses provider networks.
Looking for dental, vision and hearing coverage?
How Much Does Medicare Cost in NJ?
If you’re trying to budget for Medicare plans, you’ll start with a few standard costs. What you’ll ultimately pay, however, comes down to your medical needs and the plan (or plans) you choose. As a starting point, here are the costs you can expect to pay for Medicare in 2025:
Medicare Part A
Premium:
- Typically no cost if you or your spouse worked 10 or more years
- You or your spouse worked between 7.5 and 10 years: $285 a month
- You or your spouse worked fewer than 7.5 years: $518 a month
Deductible:
- $1,676 each plan period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare in NJ: Part B
Premium:
- $185 monthly and up (income-based)
Deductible:
- $257 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- No more than $590 in 2025
Copayments & coinsurance:
- Plan- and drug-specific
What Are Parts of Medicare?
There are four main parts to Medicare:
- Medicare Part A
- Medicare Part B
- Medicare Advantage (Part C)
- Medicare Prescription Drug Plan (Part D)
What Does Medicare Cover in NJ?
You are wondering if Medicare in New Jersey has your needs covered? Here are some of the benefits you can expect from the different parts of Medicare.
Medicare Part A Coverage
Provides hospital benefits, including:
- Inpatient care
- Skilled nursing facility care
- Hospice care
- Some home health care
Medicare Part B Coverage
Provides medically necessary and preventive services, including:
- Treatment from doctors and other medical practitioners
- Outpatient care
- Some home health care
- Durable medical equipment like wheelchairs
Medicare Part D Coverage
Provides prescription drug services:
- Generic, brand-name and specialty drugs
- Commercially available vaccines (unless covered by Part B)
Medicare Advantage (Part C) Coverage
An alternative to Original Medicare (Parts A and B):
- Substitutes for Original Medicare and offers the same benefits.
- Most Medicare Advantage plans include Part D coverage
- Often include supplemental coverage like vision, dental, and hearing
Your Ideal Medicare Plan is out there.
Pros and Cons of Medicare Advantage Plans
In New Jersey, more people are enrolled in Original Medicare than in Medicare Advantage plans. But that doesn’t mean you should ignore Part C. If you’re choosing between Original Medicare and Medicare Advantage, here are the main characteristics to consider:
- Original Medicare tends to have higher costs but offers more flexibility to see any doctor that accepts Medicare.
- Medicare Advantage uses provider networks in exchange for lower out-of-pocket costs.
What Are the Top Medicare Advantage Plans?
If you’re trying to find the top Medicare Advantage plans in New Jersey, the answer comes down to your preferences and personal details. Medicare Advantage typically includes additional services, like vision, dental, hearing, and Part D. You should also know how to compare Medicare Advantage in New Jersey and how different plans affect your coverage.
The four types of Medicare Advantage plans are:
- Health Maintenance Organization (HMO): HMOs use primary care physicians that manage your care and refer you to other providers within your network.
- Preferred Provider Organization (PPO): PPOs use primary care physicians but allow flexibility to see out-of-network providers
- Private Fee-for-Service (PFFS): PFFS plans pay providers separately for each service they provide.
- Special Needs Plans (SNP): There are two types of SNP plans: D-SNP and C-SNP. Dual eligible enrollees can qualify for D-SNP. Enrollees with certain chronic conditions can qualify for C-SNP.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,497,150 people are enrolled in Medicare Part A and B in New Jersey. The total number of beneficiaries enrolled in Medicare Advantage increased from 510,896 to 557,494 year over year. Medicare Advantage participation in New Jersey went from 34.80% to 37.24% year over year. If you’d like to dive deeper into how Medicare in New Jersey breaks down across the state, we provide a glance at who is using Medicare and how.
1,497,150 Beneficiaries with Part A & Part B
557,494 Medicare Advantage Beneficiaries
37.24% Medicare Advantage Participation Rate
56.69% Female
43.31% Male
76.80% Non-Hispanic White
8.36% African American
7.07% Hispanic
7.78% Other/Unknown
13.60% Eligible for Medicaid
1.04 Average HCC Score
$12,248.01 Actual Per Capita Costs
19.29% Hospital Readmission Rate
24.90% % of Beneficiaries with an Emergency Department Visit
510,896 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
34.80% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
State of New Jersey Department of Human Services Division of Aging Services (DoAS)
NJ Save: 1-800-792-9745
https://www.nj.gov/humanservices/doas/
What should I know about the New Jersey DoAS?
Apply for financial assistance to help pay for your Medicare premiums, prescription drugs, and more through NJ Save.
State of New Jersey Department of Human Services Division of Medical Assistance & Health Services
https://www.nj.gov/humanservices/dmahs/clients/medicaid/
What should I know about the Division of Medical Assistance & Health Services?
Sign up for Medicaid or programs geared for seniors.
New Jersey Department of Health
1-800-962-1253 for medical questions
https://www.nj.gov/health/
What should I know about the New Jersey Department of Health?
Compare medical facilities, lodge a complaint, or find local information.
New Jersey Department of Military & Veterans Affairs
Fax: 1-984-204-8343
https://www.milvets.nc.gov/contact-us
What should I know about the New Jersey Department of Military and Veterans Affairs?
NJ vets can get counseling and help with housing, education, and credit.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in New Jersey about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.gov.
- Special Needs Plans (SNP). Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.