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Medicare in New Jersey

New Jersey ensures access to Medigap Plan D for beneficiaries under age 65

Key takeaways

How many New Jersey residents have Medicare plans?

As of late 2022, Medicare enrollment in New Jersey stood at nearly 1.7 million residents. Most of them — about 90% — are eligible for Medicare due to their age (i.e., being at least 65). But roughly 10% are eligible for Medicare coverage due to a disability that lasts at least 24 months, or a diagnosis of ALS or end-stage renal disease. Nationwide, about 88% of enrollees use Medicare benefits due to age, while 12% are eligible due to disability.

Medicare options

Medicare beneficiaries have some choices to make in terms of how they access Medicare coverage and the benefits they want to have. The first choice is between Medicare Advantage, where an individual enrolls with a private health plan that is under contract with the federal government to provide Medicare coverage, or Original Medicare, where coverage is paid for directly by the federal government. Medicare beneficiaries also have options around Medigap policies and Medicare Part D (prescription drug) coverage.

The regulation of Medicare Advantage and Part D plans mostly lies with the federal government, although states are responsible for licensing the insurers and ensuring financial solvency. Medigap plans must comply with federal rules for standardization, but states have more direct oversight over these plans.

Original Medicare includes Part A (also called hospital insurance, which helps pay for inpatient stays at a hospital, skilled nursing facility, or hospice center) and Part B (also called medical insurance, which helps pay for outpatient care like a doctor appointment or a preventive healthcare service, such as most vaccinations). Medicare Advantage plans bundle Parts A and B under a single private plan and often include other services like prescription drugs and vision coverage. Beneficiaries still pay for Part B, but many Advantage plans have no additional premiums.

When it comes to Original Medicare versus Medicare Advantage, there are pros and cons to either option, and the right solution is different for each person.

Medicare Advantage in New Jersey

The majority of New Jersey Medicare beneficiaries are enrolled in Original Medicare, but Medicare Advantage enrollment has been steadily growing since 2004.

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As of 2018, about 22% of Medicare beneficiaries in New Jersey had coverage under Medicare Advantage plans. Nationwide, the average was 34%. The other 78 percent of New Jersey’s Medicare beneficiaries opted instead for coverage under Original Medicare. But in keeping with the nationwide uptick in Medicare Advantage enrollment, more than 37% of New Jersey Medicare beneficiaries were enrolled in Medicare Advantage plans as of late 2022 (versus a nationwide average of about 46% of Medicare beneficiaries enrolled in private plans).

There are 21 counties in New Jersey, and the availability of Medicare Advantage plans for 2023 ranges from 33 plans in Hunterdon County to 60 plans in Monmouth County.

Medicare beneficiaries can enroll in Medicare Advantage plans when they’re first eligible for Medicare or during the annual open enrollment period in the fall, which runs from October 15 to December 7 each year. There is also a Medicare Advantage open enrollment period each year (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can change to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Medigap in New Jersey

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

There are 26 insurers that offer Medigap plans in New Jersey.

Medigap plans are standardized under federal rules, and people are granted a six-month window, when they are at least 65 and enrolled in both Medicare Part A and Part B, during which coverage is guaranteed issue for Medigap plans. 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.

But New Jersey is among the majority of the states that have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65. And New Jersey goes further than many other states by also ensuring that people under age 65 don’t pay higher premiums for their Medigap coverage (in many states where Medigap plans are guaranteed issue for those under 65, the premiums are still higher because insurers know that disabled enrollees are likely to incur higher costs).

New Jersey’s consumer protections for disabled Medigap enrollees include provisions for those under age 50, and for those age 50-64. In both cases, as long as the person applies for a Medigap plan (Medigap Plan D, as of 2020) within six months of enrolling in Medicare Part B, the coverage is guaranteed issue and the price won’t be more than the insurer charges for enrollees who are eligible for Medicare due to their age (as opposed to a disability). But younger applicants only have one insurer option, while older applicants can select from any Medigap insurer in their area:

  • For Medicare beneficiaries who are under age 50, coverage is guaranteed issue only with the state’s contracted carrier (Horizon Blue Cross Blue Shield of New Jersey) and the available plan is Medigap Plan D (it was Plan C prior to 2020). 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. As of 2021, the monthly premium for Horizon’s Plan D for Medicare beneficiaries under age 50 was about $154/month for men and $143/month for women.
  • For Medicare beneficiaries who become eligible between the ages of 50 and 64, coverage for Plan D (it was Plan C prior to 2020) is guaranteed issue with any insurer in New Jersey that offers Medigap plans. And insurers must maintain loss ratios of at least 65% for individual policies and 75% for group policies.

Under federal law (MACRA) that was enacted in 2015, Medigap Plans C and F can no longer be sold to people who become eligible for Medicare on or after January 1, 2020. So New Jersey enacted legislation (S.3651) in 2019 to align the state’s existing law with the new federal requirements. As of 2020, Plan D is the guaranteed-issue Medigap plan for disabled Medicare beneficiaries in New Jersey, instead of Plan C.

In 2019, lawmakers in New Jersey also considered legislation (A.4834 and S.2895) to provide continuous guaranteed-issue Medigap rights to Medicare beneficiaries who are at least 65 years old, but neither bill advanced in the legislature. Similar legislation was introduced in 2023 (S.1162), but had not advanced as of late February. The current rules (which mirror federal requirements and have not yet been changed in New Jersey) only grant people a one-time six-month window during which they can pick a Medigap plan with guaranteed-issue rights. People who miss that window or pick a less-than-ideal Medigap plan are often unable to pick a different plan later on, because insurers can use medical underwriting to determine eligibility for coverage after that one-time enrollment window closes.

New Jersey Medicare Part D

While not a covered benefit under Original Medicare, coverage for outpatient prescription drugs via a Medicare Advantage plan (MA-PD), an employer-sponsored plan (offered by a current or former employer), or a stand-alone prescription drug plan (PDP).

As of late 2022, there were 876,199 Medicare beneficiaries in New Jersey who were enrolled in stand-alone Part D prescription drug plans. That number has been falling though — it was above 913,000 at the end of 2019 — due to increasing enrollment in Medicare Advantage plans, most of which include integrated Medicare Part D prescription coverage.

Total enrollment in Medicare Part D in New Jersey, including stand-alone plans as well as Part D coverage integrated with Medicare Advantage plans, stood at 1,315,907 as of late 2022, and that number has been steadily increasing along with the overall increase in Medicare enrollment.

New Jersey does still have higher than average enrollment in stand-alone Medicare Part D plans, with about 52% of the state’s total Medicare population enrolled in stand-alone Part D plans, versus about 36% nationwide. That makes sense when we consider that Medicare Advantage enrollment is lower than average in New Jersey, and Original Medicare enrollment is higher than average (most people with stand-alone Part D plans buy them to supplement Original Medicare, since most Medicare Advantage plans include Part D coverage).

For 2023 coverage, there are 24 stand-alone Part D plans available in New Jersey, with monthly premiums ranging from $7 to $121.

Medicare Part D enrollment is available when a person is first eligible for Medicare and during the annual open enrollment period in the fall (October 15 to December 7, with coverage effective January 1).

How does Medicaid provide financial assistance to Medicare beneficiaries in New Jersey?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in New Jersey includes overviews of these programs, including long-term care coverage, Medicare Savings Programs, and eligibility guidelines for assistance.

Helpful resources for New Jersey Medicare beneficiaries and their caregivers

These resources provide free assistance and information about Medicare programs and availability in New Jersey.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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