Recent data reports have shown that New Jersey residents may not be fully maximizing the Medicare benefits available to them. Approximately 68% are enrolled in the Original Medicare program, leaving 32% using Medicare Advantage or other plans. For the rest of the U.S., the average beneficiary enrolled in MA plans is a full 5% higher. The cost of Premiums for MA plans is trending slightly higher for New Jersey residents than the national average but not by much.
The average premium in New Jersey is $23.23 (down since 2020) and $21.00 for the rest of the nation. This low premium is one of the reasons to consider upgrading your care with a Medicare Advantage Plan vs. staying on Original Medicare.
You Can Get Additional Benefits
Medicare Advantage (MA) is a type of Medicare plan offered by private insurance companies and not the government. MA plans cover the basic services offered by both parts of Original Medicare Plans (Part A or hospital care and Part B which is outpatient and preventative care).
In addition, MA providers may also include perks like vision and dental care. Some may even include free or discounted gym memberships! Most MA plans will also offer some degree of prescription drug coverage (or Part D) also.
Choose from Many Types of Plans
Under the MA Umbrella, there will be other plans to shop from, depending on your needs, lifestyle, and budget. Here’s a quick look at the options:
-Health Maintenance Organization (HMO): As a plan member, you must stay within a set network of providers for coverage. Prescriptions are usually included.
-Preferred Provider Organization (PPO): You can see doctors, hospitals, and other providers that are out of network, but you’ll pay more. Prescriptions are usually included.
-Private Fee for Service (PFFS): Just like a PPO plan, all healthcare providers are covered, even outside the network. But using in-network providers will save you money. The PFFS plans are unique in that your provider will decide how much you pay for your services. Prescriptions aren’t always included.
-Special Needs Plans (SNP): This plan is specific to members with certain pre-existing conditions that must be considered. SNPs will offer prescription drug coverage.
-Medical Savings Account (MSA): A plan that deposits funds into an account solely used for healthcare expenses. Usually have a high-deductible, and prescription coverage is not offered.
When to Enroll in Medicare Advantage
Beneficiaries can enroll in MA plans when they’re first eligible or during the Annual Open Enrollment Period from October 15 to December 7. There is also an MA open enrollment each year from January 1 to March 31.
What If I Stay on Original Medicare?
Should you decide to stick with Original Medicare, you’ll be able to add other coverage as a New Jersey resident.
Medicare Supplement (Medigap) plans are used to supplement Original Medicare and may cover the out-of-pocket costs for coinsurance and deductibles. They are standardized under federal rules and allowed at 65. However, federal rules do not guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.
Some states are choosing to enforce new rules that will ensure some access to Medigap plans for residents under the age of 65. Fortunately, New Jersey is among them. The Garden State goes even one step further than most by also assuring people under age 65 are not susceptible to higher premiums for their Medigap coverage.
Give Us a Call
For more information on the Medicare Advantage plans available in your area, please call 1-800-549-6804!
Thomas M. Brzezinski is one of the founding partners of WMAG William & Michael Advisor Group LLC and Jersey Insurance Solutions. He has been involved in the insurance industry for over ten years and specializes in developing client relationships that last a lifetime.
