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Medicare NJ: A Complete Guide

Are you one of nearly 1.5 million Medicare beneficiaries in New Jersey? Or are you on your way to turning 65 and becoming eligible for New Jersey Medicare? There’s a lot to learn - and it’s all in this guide.

A Complete Guide to New Jersey Medicare includes:

About New Jersey Medicare

Medicare is largely a federal program. That means that for the most part, Medicare is the same in every state. However, each state, including New Jersey, has certain liberties when it comes to coverage. Several insurance companies in New Jersey have their own private Medicare Advantage and Medicare Supplement plans that could be better for you than Original or “traditional” Medicare.

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What is covered by New Jersey Medicare?

New Jersey Medicare is split into five different parts: Part A (hospital coverage), Part B (medical coverage), Part C (Medicare Advantage), Part D (prescription drug coverage), and Medicare Supplements (Medigap). Every Medicare beneficiary will begin with Parts A and B, which are considered “Original Medicare.”

Once you have Original Medicare, you have some choices. You can essentially choose from the following combinations:

  • Medicare Advantage with prescription drug coverage
  • Original Medicare + Part D
  • Original Medicare + Medigap
  • Original Medicare + Part D + Medigap

Technically, you do not have to enroll in a plan that includes prescription drug coverage. However, if you decided to add prescription drug coverage later, you would face a late enrollment penalty fee. It is recommended that you enroll in Original Medicare and a form of prescription drug coverage during your initial enrollment period.

Are you eligible for NJ Medicare?

NJ Medicare eligibility is based on your age and your health. Medicare was originally created as a health care system for the elderly, but it has expanded to include those who are under 65 and disabled. You can be eligible for NJ Medicare if any of the following apply to you:

  • Age 65 or older
  • Diagnosed with ALS (Amyotrophic Lateral Sclerosis, otherwise known as Lou Gehrig’s Disease)
  • Diagnosed with ESRD (End-Stage Renal Disease)
  • Receiving dialysis or have had a kidney transplant
  • Have been receiving Social Security disability benefits for at least 24 months

Types of New Jersey Medicare Plans

If you want more coverage than what Original Medicare provides, you’ll want to add either a Medicare Advantage plan or a Medicare Supplement plan - you can’t have both. There are six main types of Medicare Advantage plans in NJ, and ten main types of Medigap plans.

Medigap Plans NJ

Medigap Plans in New Jersey can be slightly different based on the carrier you choose, but generally are as follows:

Medicare Supplement Plan Benefits | New Jersey Medicare | Medicare Plan Finder

Medicare Advantage Plans in NJ

There are six major types of Medicare Advantage plans in NJ:

  • HMO (Health Maintenance Organization)
  • POS (Point-of-Service)
  • PPO (Preferred Provider Organization)
  • PFFS (Private Fee-For-Service)
  • SNP (Special Needs Plans)
  • MSA (Medicare Savings Account)

To learn more about these plan types, visit our Medicare Advantage guide.

Medicare Providers New Jersey

If you have a New Jersey Medicare Advantage or Medicare Supplement plan, you should check with your plan or carrier for a list of providers who accept your plan. If you have Original Medicare, you can use the Medicare.gov search tool to find doctors, hospitals, and pharmacies in New Jersey that accept Medicare.

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Medicare Prescription Plans NJ

To get New Jersey prescription drug coverage, you can select a Medicare Part D plan (stand-alone prescription drug coverage) or either a Medicare Advantage or Medicare Supplement plan that includes prescription drug benefits. If you select a Part D plan or Medicare Supplement plan, your premium, copayment, and your network will all be separate from your Original Medicare (Part A and Part B). If you select Medicare Advantage, all your coverage will be rolled into one plan with one premium. Your provider network and any other costs, like your deductible, copayments, and coinsurance, can all be found in your one Medicare Advantage plan.

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New Jersey Medicare Resources

The state of New Jersey provides financial resources for Medicare beneficiaries who need more help paying for their health plan(s). You may be eligible for one or more programs!

NJ Save

If you need more help paying for your Medicare costs, you can apply for NJ Save! If you are eligible, you can be enrolled in:

  • PAAD (Pharmaceutical Assistance to the Aged and Disabled)
  • Senior Gold Prescription Discount Program
  • Lifeline Utility Assistance
  • Various Medicare Savings Programs
  • Low Income Subsidies (Extra Help)
  • HAAAD (Hearing Aid Assistance to the Aged and Disabled)

If you qualify for NJ Save Programs, you may also qualify for a few other financial assistance programs. The NJ Save program can forward your information to the NJ SNAP (food stamps) program, the Low-Income Heating and Energy Assistance Program (LIHEAP), and the Universal Service Fund (USF). Note that if you are eligible for these programs, it is highly likely that you are also eligible for a property tax freeze, reduced vehicle fees, and even low-cost spaying and neutering for your pets. Be sure to look into your eligibility before you pay full price!

Click here to apply for NJ Save through the New Jersey Division of Aging Services.

PAAD NJ and the Senior Gold Program

PAAD, or the New Jersey Pharmaceutical Assistance to the Aged and Disabled program, helps the aged and disabled pay for prescribed drugs, insulin, insulin supplies, and injection supplies (like needles and syringes) for multiple sclerosis treatment. It does not cover diabetes testing supplies, but your Medicare Part B can. PAAD will decrease your copayment to $5 for covered generic drugs and $7 for covered brand-name drugs.

To have PAAD coverage, you must also have a Medicare Part D plan and:

  • Not be enrolled in Medicaid
  • Be over age 65 or between 18-65 and receiving Social Security Disability benefits
  • You are single and earn less than $27,189 per year or you are married and earn less than $33,334 per year

Keep in mind that you may have to reapply for PAAD NJ every year. You should receive a renewal form in the mail before your card expires.

Even if you aren’t eligible for PAAD, you may be eligible for the New Jersey Senior Gold Program. To qualify, you must earn between $33,334 and $43,334 annually, be at least 65, and be enrolled in Medicare Part D. Senior Gold members get up to 50% off of out-of-pocket drug costs with a $15 copay. If you have Senior Gold and you spend more than $2,000 on prescriptions in a year (or $3,000 if you are married), Senior Gold will cover 100% of out of pocket costs (except for the $15 copay).

PAAD NJ Application

To apply for PAAD NJ, you will also apply for other NJ Save programs. Click here for the PAAD NJ Application.

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Lifeline Utility Assistance

There are three programs included in the New Jersey Lifeline Utility Assistance program. The Lifeline Credit Program provides $225 annually in credit for beneficiaries to use towards utility bills, the Tenants Lifeline Assistance Program provides $225 in check form annually for tenants who have utilities included in rent, and the Special Utility Supplement program provides up to $18.75 per month for utility payments to those who have Supplemental Security Income.

To be eligible for Lifeline Utility Assistance, you must either be a PAAD beneficiary or a recipient of MAA (Medical Assistance to the Aged), MAO (Medical Assistance Only), or New Jersey Care (Medicaid). The program only allows one application per household.

HAAAD (Hearing Aid Assistance to the Aged and Disabled)

HAAAD offers $100 reimbursements for hearing aids each calendar year. You will need to apply every year if you need new hearing aids. You must meet the PAAD or Lifeline eligibility to be eligible for HAAAD.

How to Apply for Medicare in New Jersey

You can apply for Medicare in New Jersey by visiting your local Social Security Administration office or the Social Security website or by calling 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday from 7 AM to 7 PM. If you have worked for a railroad, enroll through the Railroad Retirement Board at 1-877-772-5772 (TTY 312-751-4701), Monday through Friday from 9 AM to 3:30 PM.

If you have received  Social Security Disability benefits for 24 months, you will be automatically enrolled in your 25th month of benefits.

For help selecting a Medicare plan, find a benefits advisor in your area!

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