Table of Contents

Medicare Plans by State

STATE -Select-
  • Alabama
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Page Reviewed / Updated – September 17, 2022

Medicare Advantage in New Jersey is a senior health care plan that seniors can choose as an alternative to Original Medicare. One of the major differences between the two options is that private insurance companies offer Medicare Advantage whereas the federal government manages Original Medicare. Each Medicare Advantage provider must be approved by Medicare and provide at least the same level of services covered under Original Medicare. The only exception to this requirement is hospice care, which is always covered under Original Medicare despite the senior’s plan.

Another difference between the two plans is that Medicare Advantage combines Medicare Plan A, Medicare Part B and typically Medicare Part D (prescription) into one bundled package. Many Medicare Advantage plans also include additional benefits, such as wellness programs, hearing aids, and dental and vision care. Medicare Advantage plans may also require seniors to seek services for health care providers within the plan’s network. Out of the more than 1.5 million eligible seniors residing in New Jersey, over 500,000 are enrolled in Medicare Advantage, according to data from 2020. This number represents almost 32% of all Medicare users, which is lower than the state average of 42%.

The following guide offers a closer look at Medicare Advantage options in New Jersey, including a list of the top 10 providers. It also provides information regarding eligibility and how Medicare Advantage in the state works.

The Top 10 Medicare Advantage Plans in New Jersey

Eligible seniors living in New Jersey can choose between more than a dozen different Medicare Advantage providers. Seniors can learn more about their options by viewing the table below. Individuals younger than 65 with certain disabilities can also apply for Medicare Advantage.This table provides details about the top 10 Medicare Advantage providers in New Jersey, based on enrollment numbers. It also denotes the plan types offered by each provider listed, the provider’s Medicare star rating and monthly costs. Since many Medicare Advantage providers in New Jersey offer several plan options, monthly costs are listed as a range and enrollment numbers for each plan type per provider are combined for final amounts. This information is current as of April 2022. For more information about each plan

Name

Total Enrollment

Star Rating

Min Cost

Max Cost

Plan Types

Aetna Medicare

223,708

4

$0

$135

HMO, PPO

UnitedHealthcare

183,592

4

$0

$199

HMO, PPO

Clover Health

69,984

3

$37

$37

HMO, PPO

Wellcare

27,137

3.5

$0

$18

HMO, PPO

Braven Health

25,901

0

$0

$35

HMO, PPO

Amerigroup Community Care

24,171

3.5

$34

$34

HMO

Humana

20,188

4

$0

$33

HMO, PPO

Horizon Blue Cross Blue Shield New Jersey

17,397

0

$0

$0

HMO

Horizon Blue Cross Blue Shield of New Jersey

8,074

3.5

$30

$78

HMO, PPO

Cigna

4,906

3.5

$30

$60

HMO, PPO

How Medicare Advantage Plans Work in New Jersey

Seniors comparing Medicare Advantage plans in New Jersey should first understand how these plans work. Medicare Advantage providers in New Jersey offer one or more of the following four plans: health maintenance organizations (HMO) plan, preferred providers organizations (PPO) plan,private fee-for -service (PFFS) and special needs plan (SNP). This variety allows seniors to choose the plans that are best for them. Each plan has its own policies regarding referrals, deductibles and copays and has different requirements pertaining to in-network providers and primary care doctor designations. For more information, see the table below for a brief description of the main types of care plans available in New Jersey.

What Medicare Advantage Plans Cover in New Jersey

Medicare Advantage plans in New Jersey are required to cover at least the same services provided by Medicare Part A and Medicare Part B, such as regular doctor visits, X-rays, lab tests, preventive screenings and hospital care. Hospice care is always covered under Original Medicare, even for those with a Medicare Advantage plan. Many Medicare Advantage plans also offer other benefits, such as dental and vision care, hearing aids and prescription drugs.



Coverage Available With Medicare Parts A & B?

Coverage Available With Medicare Advantage?

Preventive Screenings

Yes

Yes

Hospital Care

Yes

Yes

Durable Medical Equipment

Yes

Yes

Prescription Drugs

No

Yes**

Vision Care

No

Yes*

Dental Care

No

Yes*

Hearing Aids

No

Yes*

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in New Jersey

To be eligible for Medicare Advantage in New Jersey, seniors must be over 65 years old or have a qualifying disability and already be enrolled in or be eligible for Medicare Part A and Medicare Part B. Seniors must also be U.S. citizens or permanent legal residents, live within the plan’s specific service area and meet all other plan requirements.

Similar to most insurance plans, seniors must enroll in a Medicare Advantage plan or switch from Original Medicare to Medicare Advantage during the designated open enrollment period unless they experience a qualifying event. It’s important for seniors to understand when their specific open enrollment period begins and ends. See the information and table below for details regarding these open enrollment dates.

  • Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
  • Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
  • Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Start Date

End Date

Initial Coverage Election
Period

3 Months Before One’s
65th Birth Month

3 Months After One’s
65th Birth Month

Annual Election Period
(AEP)

October 15th

December 7th

Medicare Advantage Open
Enrollment Period

January 1st

March 31st

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in New Jersey

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.




State-Wide Medicare Advantage Resources

Senior Health Insurance Assistance Program

The New Jersey Department of Human Services Division of Aging Services provides free assistance for New Jersey Medicare beneficiaries through its Senior Health Insurance Assistance Program. This statewide program utilizes trained counselors who provide information and assistance about Medicare and Medicare Advantage options, benefits, claims and supplement policies, including Medigap. Counselors never provide legal advice or endorse any specific insurance plan, product, agent or company, but supply the information seniors need to make their own decisions. Assistance may also include information about prescription drug coverage, evaluation of specific health insurance needs and help completing Medicare enrollment and health insurance claim forms.

Contact Info

For Medicare counseling and general aging services questions, call the State Health Insurance Assistance Program toll free at 1-800-792-8820 or search for your local SHIP office online.

Visit Website
Aging & Disability Resource Connection/Area Agency on Aging

The State of New Jersey Department of Human Services Division of Aging Services also administers the Area Agencies on Aging (AAAs) and the Aging & Disability Resource Connection. Each of New Jersey’s 21 counties have a dedicated AAA to serve older adults, which also operates the ADRC program in each county. Together, these programs ensure seniors and adults with disabilities have easy access to information about long-term care. Services include providing information about Medicare, Medicare Advantage, Medicaid, Medicare Part D prescription drug coverage and long-term care. Counseling and assistance about Medicare eligibility and application processes are also provided.

Contact Info

Get more information about ADRC services by calling 1-877-222-3737 toll free or search for your local Area Agency on Aging online.

Visit Website

Local Medicare Advantage Resources

Passaic County Department of Senior Services, Disabilities and Veterans’ Affairs

The Passaic County Department of Senior Services, Disabilities and Veterans’ Affairs in Totowa, New Jersey, acts as the county’s State Health Insurance Plan Coordinator and Area Agency on Agency, and operates the Aging & Disability Resource Connection that assists Medicare beneficiaries in and around Passaic County. New Jersey residents receive free Medicare counseling, assistance with benefits screening, entitlement consultations and information about Medicare Advantage, Medicare Part D and Medigap coverage. Staff can also help beneficiaries qualify for the Pharmaceutical Assistance to the Aged & Disabled program, which helps eligible seniors aged 65 or older and disabled individuals save money on prescription drug costs.

Contact Info

To inquire about any of the services provided by the Passaic County Department of Senior Services, Disabilities and Veterans’ Affairs call 973-569-4060 or send an email to [email protected].

Email
Sussex County Division of Senior Services

The Sussex County Division of Senior Services operates the Aging & Disability Resource Connection in Newton, New Jersey. Medicare beneficiaries throughout the ADRC’s service area receive help with their health insurance, including Medicare, Medicare Advantage, Medicaid and other insurance options. Assistance is also available with Medicare Part D prescription drug plans, special benefits under the Medicare Improvements for Patients and Providers Act, Medigap and Medicare billing issues. All programs are free and available for seniors and adults with disabilities, regardless of income.

Contact Info

For more information about any of the programs offered by the Sussex County Division of Senior Services, call 973-579-0555 or email [email protected].

Email
Cape May County Department of Aging & Disability Services

Medicare beneficiaries feeling overwhelmed by health and prescription insurance plan choices can find assistance at the Cape May County Department of Aging & Disability Services in Rio Grande, New Jersey. This program offers free, one-on-one counseling from experienced State Health Insurance Assistance Program counselors who can help Medicare beneficiaries make informed health care decisions and choose the right coverage to meet their needs. SHIP counselors also provide assistance with Medicare Part B premium savings, Medicare Advantage plans, Medicare Part D prescription plans and Medigap policies. They can also answer questions about claims and billing issues, and help seniors apply for state prescription assistance programs.

Contact Info

Schedule Medicare counseling or ask health insurance-related questions by contacting Aging & Disability Services in Cape May County at 609-886-2784.

Visit Website
Middlesex County Office of Aging & Disabled Services

Middlesex County seniors with questions about Medicare insurance plans, benefits, claims, supplemental policies or long-term care insurance can receive free assistance and counseling through the Middlesex County Office of Aging & Disabled Services‘ State Health Insurance Program. Trained SHIP counselors provide help to Medicare beneficiaries with any type of question or problem related to Medicare, Medicaid, Medicare Advantage, Medicare Part D or other health insurance coverage and benefits. Counselors can also assist seniors in evaluating their health insurance needs, dealing with Medicare claims and applying for or changing Medicare coverage or prescription drug coverage, as well as help low-income seniors and disabled persons save money on prescription costs and Medicare premiums.

Contact Info

For a counseling appointment or assistance with any Medicare question, call SHIP counselors from the Middlesex County Office of Aging & Disabled Services directly at 732-745-3295. Jewish Family Services also has trained SHIP counselors contracted to help the Middlesex County office in assisting seniors with the Medicare program. Call their Milltown office at 732-777-1940 or their Monroe Township office at 609-395-7979.