If you live in New Jersey, you may want to know about the Medicare options in your state. Original Medicare (Part A and Part B) is not the only Medicare option you have to choose from. Original Medicare doesn’t cover certain services like hearing, vision, dental, or wellness programs. If you want these added benefits, you may want to check out Medicare Advantage (Medicare Part C) plans.
Medicare-approved private insurance companies offer these Medicare Advantage plans. They are another option if you don’t want the government-run Original Medicare program. By law, these plans must give you at least the same level of coverage as Original Medicare (Part A and Part B). These plans may also give you extra benefits beyond Original Medicare. Medicare Advantage plans vary in benefits depending on where you live and what plan you choose.
The zip code and county that you live in determines what type of Medicare Advantage plan options are available to you. The following are the kind or options that you may have:
- HMO (Health Maintenance Organization) plans: If you want a cheaper plan with a network of providers, this plan may be the right fit for you. This plan covers a network of providers and does not cover providers outside the network (unless in a medical emergency). A primary care doctor will take care of most of your health needs and if you want to see a specialist, you will need a referral from your primary care doctor. HMOs are one of the more popular choices for a Medicare Advantage plan.
- PPO (Preferred Provider Organization) plans: PPO’s offer more freedom to what providers you can choose. You will also have a network of providers in this plan but PPOs will cover out-of-network providers too. If you use doctors inside of the plan’s network, cost sharing will generally be lower than if you used out-of-network doctors. You are not required to have referrals for specialist care or a primary care doctor.
- Special Needs Plans (SNP): You can qualify for enrollment for this plan if you reach certain unique needs. You are eligible if you have Medicare and Medicaid (dual-eligibility), live in an institution like a nursing home, or have certain chronic conditions. You must meet the qualifications and have a Special Needs Plan in your service area for you to be eligible to enroll. These plans specialize in treating the specific needs of its members. For instance, if you have a specific chronic condition like AIDS, this plan has a network or providers who specialize in treating people with AIDS. This plan also has a list of prescription medication to further remedy the condition.
- Private Fee-for-Service (PFFS) plans: These plans do not have a network of providers like HMOs or PPOs. You will be able to see any provider with this plan. The provider must accept the plan’s terms and conditions and agree to treat you with each service that you get. There are some PFFS plans with provider networks as they are an exception to this rule.
- Medicare Savings Account (MSA): This plan is a combination of a medical savings account with a high annual deductible health plan. You get a savings account in which your Medicare Savings Account plan will deposit money into every year. You will be able to use this money to pay for your health-care costs prior to covering your deductible.
What to know about Medicare Advantage Prescription Drug plans in New Jersey
One benefit of Medicare Advantage is that it can include prescription drugs while Original Medicare does not. You have to enroll in a stand-alone prescription drug plan (Medicare Part D) if you want prescription drugs with Original Medicare. With Medicare Advantage (Medicare Part C), you can get prescription drug coverage included with the plan. These Medicare Advantage plans are called Medicare Advantage Prescription Drug plan. They will cover your health care and prescription drug coverage all under one plan.
Before signing up to a Medicare Advantage Prescription Drug plan, check if it has the prescription drugs you need. To check, you must look at the formulary which is a list of prescription drugs that the plan covers. The formulary is subject to change at any time and if it does, the plan will notify you. Please note that each plan varies in the benefits and costs.
Researching Medicare Advantage plans in New Jersey
If you want to sign up for a Medicare Advantage plan, you should research your plan options available to you. The benefits and costs will vary from each Medicare Advantage plan choice in your area. Be aware that some Medicare Advantage plans may have free monthly premiums (not available everywhere) . Even though they may have free premiums does not mean you are exempt from other costs like coinsurance, copayments, and deductibles. You also must pay your monthly Medicare Part B premium in a Medicare Advantage plan.
Do you need help comparing Medicare Advantage plan options in your area? Then contact us and a licensed insurance can assist you in finding the best coverage that best fits your needs.