What makes Medicare different in New Jersey
Original Medicare, the standard Part B premium, and the main enrollment periods are set at the federal level. What sets New Jersey apart is everything around them:
- State prescription programs: PAAD and Senior Gold help eligible residents with drug costs, but both require you to enroll in a Medicare Part D plan.
- Medicare Supplement access under 65: New Jersey requires Medicare Supplement coverage to be available to people under 65 who are on Medicare because of a disability.
- Public employee retiree rules: retirees in the State Health Benefits Program and School Employees' Health Benefits Program must enroll in Medicare Parts A and B to keep their coverage.
- Two neighboring medical hubs: some residents see specialists in New York City or Philadelphia, which matters for plans with local networks.
- An aging population: several counties, including Cape May, now have more residents 65 and older than children, and the Shore is home to many 55+ communities.
Medicare Advantage in New Jersey
Medicare Advantage plans in New Jersey include HMO and PPO options, and the plans available to you depend on your county. A plan that's offered in Bergen County may not be offered in Cape May County, and networks can change from year to year.
New Jersey has several large health systems, including Hackensack Meridian Health, RWJBarnabas Health, Atlantic Health System, and Virtua Health. Not every Medicare Advantage plan includes every system in its network, so it helps to know which hospitals and doctors you want before you compare. If you see specialists across the river in New York or Pennsylvania, check whether those providers are in network too. Medicare at 65 is not affiliated with these health systems.
Employer and retiree group Medicare Advantage plans are especially common here: New Jersey has one of the highest shares of Medicare Advantage enrollees in group plans in the country. If a former employer offers retiree coverage, compare it carefully before choosing an individual plan.
For people who have both Medicare and NJ FamilyCare (Medicaid), New Jersey offers Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), which coordinate both programs in one plan with one ID card. Learn how Medicare Advantage works.
Medicare Supplement (Medigap) in New Jersey
Medicare Supplement plans in New Jersey use the same standardized lettered plans found in most states, such as Plan G and Plan N, but premiums vary by insurer. New Jersey's Division of Aging Services publishes Medicare Supplement premium comparison charts by age and a list of insurers offering policies in the state, which can make price shopping easier.
You can apply for a Medicare Supplement policy at any time of year, because the fall Annual Enrollment Period doesn't apply to Medigap. Timing still matters: during your first six months with Part B, and in guaranteed-issue situations, insurers can't use medical underwriting. After that, they may turn you down or charge more based on your health. New Jersey insurers can also raise rates at any time of year with approval from the New Jersey Department of Banking and Insurance.
Under 65 and on Medicare because of a disability?
New Jersey requires access to Medicare Supplement coverage for people under 65 who qualify for Medicare because of a disability:
- Which plan: Plan D if you became eligible on or after January 1, 2020, or Plan C if you became eligible before then.
- Under 50: you're charged the same premium the carrier charges someone age 65 for that plan.
- Ages 50 to 64: the carrier can't charge more than it charges a 65-year-old for the same policy.
- At 65: you get a new six-month Medigap Open Enrollment Period to buy any Medicare Supplement plan sold in New Jersey.
Application time limits apply, so it's best to act soon after you become eligible. Learn how Medicare Supplement plans work.
Prescription coverage: Part D, PAAD, and Senior Gold
New Jersey has its own state prescription assistance programs for older adults. Both work alongside Medicare Part D rather than replacing it, and both require New Jersey residency and that you be 65 or older or receiving Social Security disability benefits.
- PAAD (Pharmaceutical Assistance to the Aged and Disabled): for residents with lower incomes. Members pay a small fixed copay for each covered generic or brand name prescription.
- Senior Gold: for residents whose income is somewhat above the PAAD limit. Members pay a copay plus a share of each covered drug's cost, and pay only the flat copay once their out-of-pocket costs for the year reach a set amount.
Medicare-eligible members of both programs must enroll in a Medicare Part D plan, and income limits are updated each year. PAAD doesn't cover drugs purchased outside New Jersey, which matters if you fill prescriptions while traveling.
Retiring from a New Jersey public employer?
If you're retiring with coverage through the State Health Benefits Program (SHBP) or School Employees' Health Benefits Program (SEHBP), Medicare becomes a requirement, not an option:
- Part A and Part B: if you or a covered dependent is eligible for Medicare but doesn't enroll in both, SHBP or SEHBP coverage will be terminated.
- Plan choices: Medicare-eligible retirees can choose an Aetna Medicare Advantage plan or a Horizon Medicare Supplement plan through the program.
- Drug coverage: if you're in an SHBP or SEHBP Medicare Advantage plan and enroll in an individual Medicare Part D plan instead, your program Medicare Advantage plan will be terminated.
- Part B reimbursement: whether you're reimbursed for Part B premiums depends on your service credit and the agreement in place when you retired.
Confirm your specific situation with the New Jersey Division of Pensions and Benefits before your retirement date. For private-sector retirements, see how Special Enrollment Periods work when employer coverage ends.
Help paying Medicare costs in New Jersey
New Jersey's Medicare Savings Programs (QMB, SLMB, and QI) can help pay Medicare premiums, and QMB also helps with Medicare deductibles and coinsurance. You can apply for them, along with other state programs, through New Jersey's NJSave application, online or on paper. Income and resource limits apply and change each year.
Medicaid in New Jersey is called NJ FamilyCare and is administered by the Division of Medical Assistance and Health Services. You may also qualify for federal Extra Help with Part D costs.
Snowbirds and people moving to or from New Jersey
- Moving to New Jersey: if your Medicare Advantage or Part D plan doesn't serve your new area, you generally get a Special Enrollment Period to choose a New Jersey plan.
- Spending winters away: most Medicare Advantage plans use local networks, while Original Medicare with a Medicare Supplement policy works with providers nationwide that accept Medicare.
- Keeping a Medicare Supplement policy: you can generally keep your policy when you move, though your premium may change.
- Updating your address: let Social Security know when you move so your Medicare records stay current.
Not sure which direction fits how you live? Compare Medicare Advantage and Medicare Supplement, or start with our Turning 65 guide.