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Medicare Advantage Plans in New Jersey

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Medicare Advantage Plans in New Jersey

In New Jersey, just like in other states, you can choose a Medicare Advantage plan, Part C, to get more coverage than through the government plans. You must have Original Medicare, Part A and B, to enroll in a Medicare Advantage plan. They are offered by private Medicare-approved insurance companies and must cover all of the services that Original Medicare covers.

Most Medicare Advantage plans may also offer benefits beyond Original Medicare, such as prescription drugs. Sometimes dental, vision and hearing services are also included.

Medicare Advantage plans also have a yearly limit on your out-of-pocket costs. After you reach this yearly limit, you won’t have to pay anything for covered services. Yearly limits vary by plan so be sure to ask about this limit when you choose your plan.

What kinds of health care benefits do Medicare Advantage plans offer?

Medicare Advantage plans include coverage for:

  • Hospital services (Medicare Part A)
  • Medical services (Medicare Part B) – including preventive care

Depending on the plan you choose and where you live, most Medicare Advantage plans may also cover:

  • Prescription drugs (Medicare Part D)
  • Routine care for your vision and hearing
  • Health, fitness and wellness programs

Medicare Advantage Part C plans you can get in New Jersey:

  • Health Maintenance Organization (HMO) plans: HMOs cover your health care through their network of doctors, specialists and hospitals. You select a primary care doctor from the network, and this doctor will coordinate your care and refer you to specialists if needed. For medical emergencies, you will be covered even outside the network.
  • Preferred Provider Organization (PPO) plans: PPOs are different than HMOs in a few key ways. With a PPO plan, you don’t need to choose a primary care doctor. Also, you don’t need referrals to see specialists. Your share of costs is usually lowest if you see doctors in the network. You also can visit providers outside of the network – you just may have to pay higher copays and/or coinsurance.
  • Private Fee-for-Service (PFFS) plans: Most PFFS plans don’t have networks. Generally you can get covered care from any doctor, specialist or hospital. Be sure to check first that they accept the plan’s terms and conditions. Read more about PFFS plans here.
  • Special Needs Plans (SNPs): These Medicare Advantage plans are designed specifically for people with chronic conditions or special health needs. The benefits, providers and covered prescription drugs are carefully chosen for these unique needs. Read more about SNPs here.

Enrolling in Medicare Advantage

Each plan has different coverage and costs, so choose the plan that’s right for your needs. Some plans have monthly premiums as low as $0. All plans have a yearly limit on your out-of-pocket costs.

You can enroll in a Medicare Advantage plan during the Initial Enrollment Period and the Open Enrollment Period. Remember you must have Original Medicare, Part A and Part B, in order to enroll in a Medicare Advantage plan.

Initial Enrollment Period: If you’re not automatically enrolled in Original Medicare, you can first enroll during the 7-month Initial Enrollment Period. This begins three months before you turn 65, your birthday month, and three months after you turn 65. You can also enroll in a Medicare Advantage plan during this time period.

Open Enrollment Period: You can also join, change or leave your Medicare Advantage plan during the Open Enrollment Period. This happens every year starting on October 15 and ending on December 7.

Things to remember:
  • Benefits and costs vary by the plan you choose and where you live.
  • With any Medicare Advantage plan, you must continue to pay your Original Medicare Part B premium.
  • Review the information and talk with a Medicare expert so you can select the plan that’s right for you.

How to sign up for a Medicare Advantage plan

  • Visit Medicare.gov
  • Search the plans you want, choose one and enroll on their website
  • Call the plan you’re interested in for a paper form to fill out
  • Call 1-800-MEDICARE (1-800-633-4227) (TTY: 711)