Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage is an alternative to Original Medicare, a health insurance option traditionally offered by the federal government to make healthcare more accessible to seniors 65 and older or for those with certain qualifying disabilities. The primary difference between the two options is that Original Medicare is administered federally while Medicare Advantage offers at least the same level of services through private insurance providers. The only exception to this is hospice care, which will always be provided by Medicare Part A, regardless of a Medicare beneficiary’s enrollment. Medicare Advantage providers must be approved by Medicare and follow strict regulations overseen by the Centers for Medicare & Medicaid Services (CMS).
In other words, Medicare Advantage or “Part C” effectively combines Medicare Part A and Part B into a comprehensive plan that also typically includes Medicare Part D (prescription drug coverage) in a package that resembles typical health insurance policies. Medicare Advantage typically also includes additional benefits, such as wellness programs, dental care and vision benefits. However, these plans usually require seniors to seek services within an approved network, whereas Original Medicare beneficiaries can see any practitioner in the nation who accepts Medicare.
In New Jersey, 1,715,881 people are eligible for Medicare Advantage enrollment as of July 2023. Of those, nearly 669,000 chose one of these plans, representing about 39% of the total eligible population. These numbers are lower than national trends, which reveal a 48% participation rate nationwide. New Jersey saw a 2.75% increase in eligible individuals compared to the 2.66% seen nationwide. Despite this, eligible seniors are opting into Medicare Advantage at slightly slower rates than seen nationwide, with an 8.3% increase in New Jersey enrollees from 2022 to 2023 compared to the 9.75% seen nationally. This amounts to a 5.41% increase in the percentage of eligible people who enrolled in New Jersey while the U.S. averaged 6.9%.
This guide provides insight into Medicare Advantage options in New Jersey, including a list of the top seven providers. It also discusses how Medicare Advantage works in the state and important information regarding eligibility.
The Top 10 Medicare Advantage Plans in New Jersey
Eligible seniors can select from several Medicare Advantage providers. The top seven providers are listed in the table below based on enrollment data. Because it’s typical for providers to offer several plans, enrollment numbers for all plans provided by a company have been consolidated to create a comprehensive ranking. Beyond enrollment, the companies’ Medicare star ratings and plan types are also provided. Monthly costs are listed as a range based on the plans offered. This information is current as of July 2023, but because plan information can change, seniors should also check Medicare.gov for the most up-to-date information.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
Aetna Medicare
221497
3.5
$0 – $120
PPO, HMO
UnitedHealthcare
156360
3.5
$0 – $197
PPO, HMO
Clover Health
71077
3.5
$0 – $35
PPO, HMO
Braven Health
41627
3
$0 – $35
PPO, HMO
Humana
31549
4.5
$0 – $36
PPO, HMO
Cigna
6942
3
$0 – $0
PPO, HMO
Amerigroup Insurance Company
2713
N/A
$0 – $0
PPO
How Medicare Advantage Plans Work in New Jersey
Seniors comparing Medicare Advantage plans in New Jersey should first understand how these plans work. Medicare Advantage providers in New Jersey offer one or more of the following four plans: health maintenance organizations (HMO) plan, preferred providers organizations (PPO) plan,private fee-for -service (PFFS) and special needs plan (SNP). This variety allows seniors to choose the plans that are best for them. Each plan has its own policies regarding referrals, deductibles and copays and has different requirements pertaining to in-network providers and primary care doctor designations. For more information, see the table below for a brief description of the main types of care plans available in New Jersey.
What Medicare Advantage Plans Cover in New Jersey
Medicare Advantage plans in New Jersey are required to cover at least the same services provided by Medicare Part A and Medicare Part B, such as regular doctor visits, X-rays, lab tests, preventive screenings and hospital care. Hospice care is always covered under Original Medicare, even for those with a Medicare Advantage plan. Many Medicare Advantage plans also offer other benefits, such as dental and vision care, hearing aids and prescription drugs.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in New Jersey
To be eligible for Medicare Advantage in New Jersey, seniors must be over 65 years old or have a qualifying disability and already be enrolled in or be eligible for Medicare Part A and Medicare Part B. Seniors must also be U.S. citizens or permanent legal residents, live within the plan’s specific service area and meet all other plan requirements.
Similar to most insurance plans, seniors must enroll in a Medicare Advantage plan or switch from Original Medicare to Medicare Advantage during the designated open enrollment period unless they experience a qualifying event. It’s important for seniors to understand when their specific open enrollment period begins and ends. See the information and table below for details regarding these open enrollment dates.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in New Jersey
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
The New Jersey Department of Human Services Division of Aging Services provides free assistance for New Jersey Medicare beneficiaries through its Senior Health Insurance Assistance Program. This statewide program utilizes trained counselors who provide information and assistance about Medicare and Medicare Advantage options, benefits, claims and supplement policies, including Medigap. Counselors never provide legal advice or endorse any specific insurance plan, product, agent or company, but supply the information seniors need to make their own decisions. Assistance may also include information about prescription drug coverage, evaluation of specific health insurance needs and help completing Medicare enrollment and health insurance claim forms.
For Medicare counseling and general aging services questions, call the State Health Insurance Assistance Program toll free at 1-800-792-8820 or search for your local SHIP office online.
Aging & Disability Resource Connection/Area Agency on Aging
The State of New Jersey Department of Human Services Division of Aging Services also administers the Area Agencies on Aging (AAAs) and the Aging & Disability Resource Connection. Each of New Jersey’s 21 counties have a dedicated AAA to serve older adults, which also operates the ADRC program in each county. Together, these programs ensure seniors and adults with disabilities have easy access to information about long-term care. Services include providing information about Medicare, Medicare Advantage, Medicaid, Medicare Part D prescription drug coverage and long-term care. Counseling and assistance about Medicare eligibility and application processes are also provided.
Passaic County Department of Senior Services, Disabilities and Veterans’ Affairs
The Passaic County Department of Senior Services, Disabilities and Veterans’ Affairs in Totowa, New Jersey, acts as the county’s State Health Insurance Plan Coordinator and Area Agency on Agency, and operates the Aging & Disability Resource Connection that assists Medicare beneficiaries in and around Passaic County. New Jersey residents receive free Medicare counseling, assistance with benefits screening, entitlement consultations and information about Medicare Advantage, Medicare Part D and Medigap coverage. Staff can also help beneficiaries qualify for the Pharmaceutical Assistance to the Aged & Disabled program, which helps eligible seniors aged 65 or older and disabled individuals save money on prescription drug costs.
To inquire about any of the services provided by the Passaic County Department of Senior Services, Disabilities and Veterans’ Affairs call 973-569-4060 or send an email to [email protected].
The Sussex County Division of Senior Services operates the Aging & Disability Resource Connection in Newton, New Jersey. Medicare beneficiaries throughout the ADRC’s service area receive help with their health insurance, including Medicare, Medicare Advantage, Medicaid and other insurance options. Assistance is also available with Medicare Part D prescription drug plans, special benefits under the Medicare Improvements for Patients and Providers Act, Medigap and Medicare billing issues. All programs are free and available for seniors and adults with disabilities, regardless of income.
Cape May County Department of Aging & Disability Services
Medicare beneficiaries feeling overwhelmed by health and prescription insurance plan choices can find assistance at the Cape May County Department of Aging & Disability Services in Rio Grande, New Jersey. This program offers free, one-on-one counseling from experienced State Health Insurance Assistance Program counselors who can help Medicare beneficiaries make informed health care decisions and choose the right coverage to meet their needs. SHIP counselors also provide assistance with Medicare Part B premium savings, Medicare Advantage plans, Medicare Part D prescription plans and Medigap policies. They can also answer questions about claims and billing issues, and help seniors apply for state prescription assistance programs.
Middlesex County Office of Aging & Disabled Services
Middlesex County seniors with questions about Medicare insurance plans, benefits, claims, supplemental policies or long-term care insurance can receive free assistance and counseling through the Middlesex County Office of Aging & Disabled Services‘ State Health Insurance Program. Trained SHIP counselors provide help to Medicare beneficiaries with any type of question or problem related to Medicare, Medicaid, Medicare Advantage, Medicare Part D or other health insurance coverage and benefits. Counselors can also assist seniors in evaluating their health insurance needs, dealing with Medicare claims and applying for or changing Medicare coverage or prescription drug coverage, as well as help low-income seniors and disabled persons save money on prescription costs and Medicare premiums.
For a counseling appointment or assistance with any Medicare question, call SHIP counselors from the Middlesex County Office of Aging & Disabled Services directly at 732-745-3295. Jewish Family Services also has trained SHIP counselors contracted to help the Middlesex County office in assisting seniors with the Medicare program. Call their Milltown office at 732-777-1940 or their Monroe Township office at 609-395-7979.
