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Medicare Advantage Plans in New Jersey

About Medicare Advantage plans in New Jersey

If you're a Medicare beneficiary in New Jersey, you may find that Original Medicare (Part A and Part B) doesn't cover certain benefits, such as routine vision or dental, hearing, or wellness programs. If you're interested in getting coverage beyond Original Medicare, you may be able to get these benefits covered through the Medicare Advantage (Medicare Part C) program.

Medicare Advantage plans are offered by private insurance companies that are approved by Medicare and provide an alternative way to get your Medicare coverage. These plans are required to cover at least the same level of benefits as Medicare Part A and Part B, while potentially offering additional benefits beyond Original Medicare. Benefits vary, depending on the specific Medicare Advantage plan and location.

There are several types of Medicare Advantage plans, and the plan options available to you will depend on your zip code and county of residence. Some of those choices may include:

  • Health Maintenance Organization (HMO) plans: HMOs are a popular type of Medicare Advantage plan, offering health-care services through a provider network of doctors and hospitals. You must use in-network providers to be covered by the plan (although you'll still be covered in medical emergencies). You'll also need to have a primary care doctor and get referrals to see specialists.

  • Preferred Provider Organization (PPO) plans: Another popular managed-care plan, PPOs offer more provider flexibility. Your cost sharing is typically lowest if you use doctors from the plan's preferred provider network, but you also have the option to go out of network and pay higher copayments. You don't need a primary care doctor or referrals for specialist care.

  • Special Needs Plans (SNP): These plans limit enrollment to people who live in institutions (such as nursing homes), have certain chronic conditions, or have Medicare and Medicaid. If you meet the eligibility criteria and there's a Special Needs Plan in your service area for people of your target group, you may be eligible to enroll. These plans cater benefits to meet the specific needs of its members. For example, a Chronic-Condition Special Needs Plan for beneficiaries with AIDS may have provider networks and formularies that are tailored towards treating people with AIDS.

  • Private Fee-for-Service (PFFS) plans: Unlike HMOs or PPOs, many of these plans don't have provider networks. Instead, you can see any provider that will accept the plan's terms and conditions and agree to treat you on a case-by-case basis. Some PFFS plans do have provider networks.

  • Medicare Savings Account (MSA): This plan combines a high-deductible health plan with a medical savings account. Every year, your Medicare Savings Account plan will deposit money into a savings account, which you can use to pay for covered health-care costs before you reach your deductible.

Medicare Advantage Prescription Drug plans in New Jersey

One feature of Medicare Part C that sets it apart from Original Medicare is that prescription drug coverage (Medicare Part D) can be included in the plan. In contrast with Original Medicare, where beneficiaries must get this coverage separately through a stand-alone Medicare Prescription Drug Plan, those with Medicare Part C can get prescription drug benefits included in their plan. Also known as Medicare Advantage Prescription Drug plans, these plans cover all of your Medicare Part A, Part B, and Part D benefits under a single plan.

Keep in mind that the specific benefits and costs vary by plan. You should always check that a Medicare Advantage Prescription Drug plan covers your prescription drugs before enrolling in the plan. It's easy to do this: Simply check the formulary, which is a list of prescription medications covered by the plan. The formulary may change at any time. You will receive notice from your plan when necessary.

Comparing Medicare Advantage plans in New Jersey

You should always take your time to research and compare Medicare plan options in your location before enrolling in a Medicare Advantage plan. As mentioned, Medicare Advantage plan options in your area will vary when it comes to benefits and costs, since these factors can depend on your county of residence. You should note that there may be Medicare Advantage plans with monthly premiums as low as $0 (this type of plan may not be available in every location). Keep in mind that even if your service area has a Medicare Advantage plan with a $0 premium, you may still have other costs, including copayments, coinsurance, and deductibles. In addition, you will need to continue paying your Medicare Part B premium.

Do you need help finding Medicare Advantage plan options in your location? An eHealth licensed insurance agent can help you find coverage solutions to fit your unique needs.

eHealth Medicare is operated by eHealthInsurance Services, Inc., a licensed health insurance agency certified to sell Medicare products.

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