Medicare in New Jersey

Garden State guarantees access to Medigap Plan C — with standard premiums — for enrollees under age 65

Resources for New Jersey beneficiaries

State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.

In New Jersey you can reach SHIP at 1-877-222-3737 or online here.

Snapshot of Medicare in New Jersey

Total Medicare enrollment in The Garden State

1,587,952 New Jersey residents were enrolled in Medicare as of November 2018. That’s a little less than 18 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare.

Read about Medicare’s open enrollment period and other important enrollment deadlines.

Breakdown of the aged vs. disabled

87 percent of New Jersey Medicare beneficiaries are eligible due to their age (ie, being at least 65), while the other 13 percent are eligible for Medicare due to a disability. Nationwide, 84 percent of Medicare beneficiaries are eligible due to age, while 16 percent are eligible due to disability.

KentuckyAlabama, and Mississippi have the highest percentage of Medicare beneficiaries who are eligible due to disability, at 23 percent (among the US territories, 31 percent of Medicare enrollees in American Samoa are eligible due to a disability, as are 23 percent in Puerto Rico). In contrast, only 9 percent of Medicare beneficiaries in Hawaii and the Virgin Islands are eligible due to a disability.

Medicare spending per recipient

In 2016, Original Medicare spent an average of $10,158 per beneficiary in New Jersey. That’s based on data that were standardized to account for regional variations in payment, but it only included Original Medicare spending, so it did not include costs for Medicare Advantage enrollees.

Nationwide, average per-beneficiary Medicare spending stood at $9,533 in 2016, so Medicare spending in New Jersey was 7 percent higher than the national average. Per-beneficiary Medicare spending was highest in Louisiana, at $11,399, and lowest in Hawaii, at $6,441.

Medigap in New Jersey

Medigap plans provide supplemental coverage for people with Original Medicare, paying some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise have to pay on their own if they only had Original Medicare without supplemental coverage (there’s no out-of-pocket maximum with Original Medicare, so out-of-pocket costs just continue to accrue. This can get particularly expensive when a person needs ongoing expensive care, such as dialysis).

Medigap plans are standardized under federal rules, and enrollees have a six-month window (starting when they turn 65 and enroll in Medicare Part B), during which coverage is guaranteed issue for Medigap plans. After that window ends, people can still apply for a Medigap plan (for the first time, or to switch plans), but the insurers can use medical underwriting to determine eligibility and pricing. And the federal rule that provides the six-month guaranteed issue window does not apply to those who are under age 65 and eligible for Medicare as a result of a disability.

But more than half the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, and New Jersey is among them. The state guarantees access to Medigap Plan C, without higher premiums, for enrollees who are under 65, as long as they enroll during the six-month window that starts when they enroll in Part B. The standard pricing is an important protection — some states have guaranteed access to Medigap plans for people under 65, but allow insurers to charge them higher premiums, since disabled enrollees are likely to incur higher costs.

  • For Medicare beneficiaries who are under age 50, coverage for Medigap Plan C is guaranteed issue at standard pricing only with the state’s contracted carrier (Horizon Blue Cross Blue Shield of New Jersey). The state runs a program so that all carriers that offer health benefits in New Jersey share in the Medigap losses incurred by the contracted carrier for these enrollees.
  • For Medicare beneficiaries who become eligible between the ages of 50 and 64, coverage for Plan C is guaranteed issue with any insurer in New Jersey that offers Medigap plans. And insurers must maintain loss ratios of at least 65 percent for individual policies and 75 percent for group policies.

Medicare Advantage in New Jersey

Medicare Advantage offers Americans health benefits through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). Medicare beneficiaries can select whether they’d rather have coverage under Original Medicare or Medicare Advantage, and there are pros and cons with either choice.

Although Original Medicare is the same nationwide, availability of private Medicare Advantage plans differs from one area to another. In New Jersey’s 21 counties, availability of Medicare Advantage plans in 2019 ranges from nine plans in Cape May County to 36 plans in Morris County.

21 percent of Medicare beneficiaries in New Jersey had coverage under private Medicare Advantage plans in 2017 (nationwide, the average was 33 percent). The other 79 percent of New Jersey’s Medicare beneficiaries had coverage under Original Medicare.

Minnesota is the only state where more than half (56 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. In Alaska, on the other end of the spectrum, just 1 percent of Medicare beneficiaries have Medicare Advantage plans.

Starting in 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead..

Stand-alone Medicare Prescription Drug plans

Original Medicare does not include coverage for outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part-D plan. Medicare Part D was created by legislation passed in 2003 and signed into law by President George W. Bush in 2006.

In 2019, there are 26 stand-alone Part D plans available in New Jersey, with premiums ranging from $12 to $102 per month.

As of November 2018, there were 912,159 Medicare beneficiaries in New Jersey enrolled in stand-alone Part D prescription drug plans. That’s about 57 percent of the state’s total Medicare beneficiaries, as opposed to about 43 percent of all Medicare beneficiaries nationwide enrolled in stand-alone Part D plans. In states where Medicare Advantage enrollment is lower than average (like New Jersey), enrollment in stand-alone Part D plans tends to be higher than average, since the plans are typically purchased to supplement Original Medicare (most Medicare Advantage plans include Part D coverage, making a stand-alone plan unnecessary).

Need health insurance in New Jersey and you’re not eligible for Medicare?

Are you under 65 years of age or otherwise not eligible for Medicare? We have information on New Jersey health insurance and the New Jersey health insurance marketplace at our health insurance site.