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Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Information for New Medicare Beneficiaries
What is Medicare
Medicare is a federal health insurance program that provides coverage to eligible individuals who are 65 years of age or older, or who have certain disabilities. In the state of New Jersey, Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) and provides coverage for a variety of medical services, including hospital stays, doctor visits, and prescription drugs. Medicare in New Jersey is divided into four parts: Part A, which covers hospital stays and other inpatient services; Part B, which covers doctor visits and other outpatient services; Part C, which is also known as Medicare Advantage and offers an alternative way to receive Medicare benefits; and Part D, which covers prescription drugs. To be eligible for Medicare in New Jersey, an individual must be a U.S. citizen or legal permanent resident and meet certain age or disability requirements.
Medicare Parts
PART A
Medicare Part A provides hospital insurance to eligible individuals. Eligibility is generally based on age (65 years or older) or disability status. Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and certain home health care services. Premium-free Part A may be available to individuals who meet certain work history requirements or those who are married to individuals with sufficient work history. For those who do not qualify for premium-free Part A, the option to purchase coverage may be available by paying a monthly premium.
PART B
Medicare Part B is a program that provides medical insurance to eligible individuals. Eligibility is generally based on age (65 years or older) or disability status. Medicare Part B covers a range of medical services and supplies that are not covered under Medicare Part A, such as physician visits, outpatient care, durable medical equipment, and preventive services. Enrollment in Part B is optional and requires the payment of a monthly premium. However, individuals who are already receiving Social Security benefits when they become eligible for Medicare may be automatically enrolled in Part B.
Medicare Part B covers a portion of the cost of covered services and supplies, and beneficiaries may be responsible for paying deductibles, co-payments, or coinsurance. Part B covers medically necessary services and supplies that are ordered by a healthcare provider. It does not cover long-term care or custodial care, which refers to nonmedical assistance with activities of daily living, such as bathing or dressing.
PART C
Medicare Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by private insurance companies that have contracted with the Centers for Medicare and Medicaid Services (CMS) to provide all the benefits covered under Medicare Part A and Part B. These plans often include additional benefits, such as prescription drug coverage, vision, and dental care, that are not covered by Original Medicare.
Enrollment in a Medicare Advantage plan requires the payment of the Medicare Part B premium in addition to any premiums or out-of-pocket costs associated with the plan. These plans may have networks of healthcare providers, such as doctors, hospitals, and other providers, that beneficiaries must use for their medical care. A referral from a primary care physician may be required in order to see a specialist.
Medicare Advantage plans can be enrolled during specific enrollment periods or in certain special circumstances. Enrollment in a Medicare Advantage plan is mutually exclusive with enrollment in Original Medicare (Part A and Part B). Beneficiaries may only enroll in one or the other, but not both.
PART D
Medicare Part D is a federal program that provides prescription drug coverage to beneficiaries with Medicare. It is administered by private insurance companies that contract with Medicare to offer Part D plans. These plans can be enrolled alongside Original Medicare (Part A and Part B) or as part of a Medicare Advantage plan that includes prescription drug coverage.
Part D plans have a formulary, or list, of covered drugs that may be organized into tiers with different cost-sharing requirements. Some drugs may require prior authorization or have quantity limits on coverage. Premiums, co-payments, and coinsurance may apply for Part D plans. These plans also have a coverage gap, which temporarily limits coverage for prescriptions. Once the coverage gap is reached, beneficiaries may pay more for their prescriptions until the out-of-pocket threshold for the year is met, at which point catastrophic coverage applies with lower co-payments or coinsurance.
Enrollment in Part D plans is available during specific periods or under certain special circumstances. Late enrollment penalties may apply if a Part D plan is not enrolled when first eligible.