According to the Centers for Medicare & Medicaid Services (CMS) over 1.5 million residents of New Jersey received Medicare coverage in 2018. Medicare beneficiaries in New Jersey have several options when it comes to Medicare coverage. Some of those coverage choices in Medicare plans include:
Original Medicare comprises of both Part A and Part B and it is a federal health-care program designed especially for seniors of age 65 and for individuals having certain health conditions like end-stage renal disease or Lou Gehrig’s disease. New Jersey residents are automatically enrolled into the Original Medicare coverage at the age of 65 if they are already receiving Social Security Administration (SSA) or Railroad Retirement Board (RRB) retirement benefits. Most of the enrollees of Medicare Part A do not have to pay a premium for Medicare Part A if they or their spouses have worked at least 10 years and paid Medicare taxes while working. Otherwise all the enrollees of Medicare Part A typically have to pay a monthly premium. Part A coverage includes inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals and if the enrollees meet specific requirements then they also become eligible for hospice or limited home health care. Medicare Part B is medical insurance that provides coverage for medically necessary doctor services, ambulance transportation, outpatient hospital care, screenings, mental health services, some home health care services and durable medical equipment. Medicare Part B also offer coverage for a range of preventive treatments, tests, services and supplies. Enrollees of Medicare Part B generally have to pay a premium for it unless they qualify for financial assistance.
Medicare Part C
Medicare Part C or Medicare Advantage plan is an alternative way of obtaining Medicare coverage in New Jersey as well as in other states. These plans are offered by private insurance companies approved by Medicare and they are supposed to provide at least the same level of benefits as Original Medicare only with the exception of hospice care. Many Medicare Part C plans also provide additional coverage beyond the federal program that may include routine dental and vision care, hearing, prescription drugs or wellness programs. Medicare Part C also gives beneficiaries the option to enroll in a Part C plan that provides coverage of all Medicare medical and prescription drug benefits through a single plan. One of the major benefit of Part C plans is these plans include an annual out-of-pocket spending limit that varies from plan to plan. Once this limit is reached, Medicare Part C covers 100% of covered medical expenses for the rest of the year. In order to be eligible for Medicare Part C, beneficiaries should have Medicare Part A and Part B and should live in the Medicare Advantage plan’s service area and should not have end-stage renal disease.
Medicare Part D
Like any other U.S. states, Original Medicare in New Jersey only cover limited prescription drugs coverage in certain situations, so medicare beneficiaries who would like to have coverage for their prescription medications need to enroll in Medicare Part D Prescription Drug Plans. To obtain Medicare prescription drug coverage, residents have two options offered by private health insurance companies having contract with Medicare. Residents can either enroll in a stand-alone Medicare Part D Prescription Drug Plan that work along with the Original Medicare coverage. For this they should be enrolled in Medicare Part A and/or Part B and they must be living in the plan’s service area. Beside this, the other option of getting Medicare prescription drug coverage is through a Medicare Advantage Prescription Drug plan. This plan coverage is similar to Medicare Part A and Part B coverage except the hospice cover. Most of these plans also include additional benefits like routine vision care. dental care as well as fitness programs. Each Medicare Part D or Prescription Drug Plan has its own formulary or list of drugs which they cover. Thus, Medicare enrollees looking for this plan are advised to check the list of drugs covered under the plan so that they make sure that their chosen Part D plan covers the medications required by them. Currently in New-Jersey, there are 26 Medicare Part-D Plans available offered by ten different health insurance providers.
Medicare Supplement Insurance Plans in New Jersey
As Original Medicare does not cover some of the healthcare expenses like deductibles, copayments, coinsurance, as well as other out-of-pocket expenses, thus Medicare beneficiaries have the option to enroll in a Medicare Supplement plan in New Jersey. The plan is also known as Medigap plan that help people cover these out-of-pocket costs. In New Jersey there are ten standardized Medigap plans available for the eligible beneficiaries. Medicare Supplement plans are also offered by the private insurance carriers and the same letter plan do not vary in terms of coverage from one insurance company to other. The coverage of each Medigap plan is same irrespective of the insurance company offering it, though the premium of these plans may vary from one company to another. Residents of New Jersey are advised to check the Medigap plans available in their area and then they should take the decision based on their health and financial needs. The best time to enroll in these plans is during the Medigap Open Enrollment Period, which is a six-month period, beginning on the first day of the month that one is age 65 and enrolled in Medicare Part B.