Comparing Medicare Advantage Plans NJ

27 minute read| Updated for April, 2021
Key Takeaways:
  • There are 74 Medicare Advantage plans currently available in NJ, including 10 new ones introduced for 2020.
  • Medicare Advantage plan options in New Jersey include HMOs, PPOs, and SNPs. 
  • Nearly all New Jersey plans include Part D coverage for prescription drugs. 
  • Although no Medicare Advantage plans in NJ earned a five-star rating, several did earn 4.5 stars for overall quality.

About 32% of New Jersey’s 1.6 million Medicare beneficiaries are enrolled in Medicare Advantage plans. That’s slightly below the national average, but it’s not due to a lack of options.

There are 74 Medicare Advantage plans currently available in NJ, 10 of which were newly introduced for 2020. This means that you have more opportunities than ever to find the perfect plan for your healthcare needs.

Here’s what you need to know about Medicare Advantage in New Jersey, including how to choose the right plan for you.

Types of Medicare Advantage Plans in NJ

There are four types of Medicare Advantage plans available under the Medicare Part C program:

In New Jersey, you can choose among 34 HMO plans, 23 PPO plans, and 17 SNPs, all of which are provided by top insurance companies, such as Aetna, UnitedHealthcare, Humana, and Horizon Blue Cross Blue Shield of NJ.

Medicare Advantage is private insurance, which means that each plan has its own benefits, restrictions, and eligibility requirements. However, each plan type does have a similar structure. The chart below shows key features of the Medicare Advantage plan types available in New Jersey. 

Medicare Advantage Plan Type Comparison

 

HMO

PPO

Uses a provider network

Yes

Yes, but you can see any provider that accepts your plan with higher out-of-pocket costs

Requires a primary care provider

Yes

No

Requires referrals for specialist care

Usually

No

Requires prior authorization for procedures

Usually

Sometimes

Includes Part D prescription drug coverage

Yes

Usually

Includes dental, vision, and hearing care

Usually

Usually

What Is a Special Needs Plan (SNP)?

A Special Needs Plan (SNP) is an HMO with membership restricted to individuals who meet the plan’s eligibility requirements.

Generally, membership in an SNP is limited to those who are dual-eligible for both Medicare and Medicaid, those who live in a long-term care facility or other institution, or those with specific health conditions.

SNPs gear their benefits to best suit the health needs of their members. For example, an SNP for people with diabetes would likely include endocrinologists as primary care providers. It might also cover podiatry services, dietician visits, and weight management counseling. The plan’s formulary would include most medications used to treat diabetes.

Most SNPs also have case managers or care coordinators assigned to each enrollee in order to make sure members are getting the treatment and services they need.

Most Medicare Advantage plans in NJ go beyond Original Medicare, providing benefits for services Original Medicare doesn’t typically cover.

Medicare Advantage vs Original Medicare

Because Medicare Advantage is private insurance, people mistakenly believe that they lose some of the benefits offered with Original Medicare. This not the case, however. The Centers for Medicare and Medicaid Services (CMS) requires that all Medicare Advantage plans cover everything that’s covered by Part A and Part B.

In fact, most Medicare Advantage plans in NJ go beyond Original Medicare, providing benefits for services Original Medicare doesn’t typically cover. For example, nearly all New Jersey Medicare Advantage plans cover routine dental, vision, and hearing care. Most also have some type of fitness benefits, like a SilverSneakers membership.

Some Medicare Advantage plans have added new supplemental benefits, which first became available in 2019. These benefits include coverage for things such as meal and grocery delivery, non-medical transportation, home safety modifications, and certain over-the-counter medications and devices.

This is all great news, meaning that you’re not missing out on any benefits or protections if you enroll in Medicare Advantage plans NJ. Also, while enrolled in these plans, the Medicare Patient’s Bill of Rights still applies to you, and you have avenues for appeal if you disagree with any decisions made by your plan. 

Medicare Advantage Plans NJ Costs

It is important to know that when you enroll in Medicare Advantage, you still have to pay your Part B premium. You may also have an additional premium for your Medicare Advantage plan. However, if your plan includes a Part D prescription drug plan, you won’t pay an extra premium for that coverage.

Many plans have an annual deductible, but you pay it only once a year. Also, there is only one deductible with Medicare Advantage, compared to the separate deductibles for Part A and Part B. There may be a separate deductible for Part D prescription drug coverage.

All Medicare Advantage plans have an annual out-of-pocket maximum. The cost varies from plan to plan, but it can’t exceed the annual limit set by CMS. For 2020, the out-of-pocket maximum is $6,700. According to the Kaiser Family Foundation, the average out-of-pocket maximum for Medicare Advantage HMOs is $4,925.

Most Medicare Advantage plans in NJ use a copayment for cost-sharing. This means that you pay a flat fee when you get care, regardless of the actual cost of your visit.

Medicare Advantage Costs at a Glance

Average monthly premium

$26, but all NJ residents have access to a $0 premium plan

Average annual deductible

$292, but $0 deductible plans are available in NJ

Average out-of-pocket maximum

$4,925

Average Part D deductible

$308

*Data from Kaiser Family Foundation and MedicareHelp.org

Understanding Medicare Advantage Part D Prescription Drug Coverage

Nearly all of the 2020 Medicare Advantage plans NJ include Part D prescription drug coverage. Although you don’t pay a separate premium for Part D, there are out-of-pocket costs associated with these benefits.

Plans are allowed to charge a Part D deductible up to the limit set by CMS. In 2020, the Part D maximum deductible is $435, although many plans set their deductible below that amount.

Most plans used a tiered formulary for Part D. A formulary is a list of medications covered by the plan and what members pay for each. CMS sets minimum coverage requirements for the basic formulary coverage, but plans can choose to cover additional medications.

In a tiered formulary, you pay lower copays for prescription drugs in the lower tiers. Copayments in the higher tiers can be a flat amount per medication or a percentage of the actual cost of the prescription drug. 

Sample Part D Formulary Tiers

Tier 1

  • Low-cost generic drugs
  • Copayments typically $0 to $10
  • May be exempt from deductible requirement

Tier 2

  • High-cost generic drugs
  • Preferred brand-name drugs
  • Copayments typically $5 to $20

Tier 3

  • Non-preferred brand-name drugs
  • Copayments typically $25 to $50
  • May have coverage restrictions

Tier 4

  • High-cost specialty drugs such as cancer and rheumatoid arthritis drugs
  • Coinsurance typically 25% to 33% of actual drug cost
  • May require prior authorization for coverage

Top-Rated Medicare Advantage Plans NJ

Medicare publishes Medicare Advantage plan ratings based on a five-star system. Plans are evaluated across 45 quality measures. The highest rating is five stars, and very few plans nationally achieve this distinction.

There are currently no five-star rated Medicare Advantage plans in New Jersey, but there are two new Clover Health plans that yet to be rated for 2020.

However, there are seven New Jersey Medicare Advantage plans that achieved a 4.5-star rating for 2020. These plans are listed below. 

Medicare Advantage Plans NJ with Top Star Ratings

Plan name

Plan type

Monthly premium

Aetna Medicare Credit Value (formerly Smart Choice)

PPO

$0 (plus $55 reduction in monthly Part B premium)

Aetna Medicare SNJ Prime Elite

PPO

$37

Aetna Medicare Prime Premier

PPO

$49

Aetna Medicare Prime Premier Plus

PPO

$84

Aetna Medicare Explorer Premier Plus

PPO

$36

Aetna Medicare Explorer Premier (formerly Standard Plan PPO)

PPO

$89

Aetna Medicare Explorer Premier 2

PPO

$104

*Data from the NJ Department of Human Services

Companies Selling Medicare Advantage Plans in NJ

The following eight insurance companies are currently approved by Medicare and the state Department of Human Services to sell Medicare Plans in New Jersey:

Amerigroup

  • Amerivantage Classic HMOs
  • Amerivantage Balance HMOs

UnitedHealthcare

  • AARP Medicare Advantage HMOs

Cigna

  • Cigna-Healthspring Preferred HMOs
  • Cigna-Healthspring Preferred Plus HMOs

Clover Health

  • Clover Health Choice PPOs
  • Clover Health HMOs

Wellcare

  • Wellcare Value HMO-POS
  • Wellcare Compass HMOs
  • Wellcare Focus HMOs

Humana

  • Humana Choice PPOs
  • Humana Gold HMOs

Aetna

  • Aetna Medicare PPOs
  • Aetna Medicare HMOs

Horizon Blue Cross Blue Shield NJ

  • Horizon Medicare Blue Advantage HMOs
  • Horizon Medicare Blue PPOs

Enrolling in Medicare Advantage Plans in NJ

Before you can enroll in Medicare Advantage, you must be signed up for Part A and Part B. The best time to do this is during your Medicare Initial Enrollment Period (IEP), which begins three months before your 65th birthday month and extends for seven months.

If you’re already enrolled in Original Medicare but want to switch to Medicare Advantage, you need to wait to do so until the fall Annual Election Period. This period takes place from October 15 to December 7 each year.

People who are already enrolled in Medicare Advantage but want to switch to a new plan can also use the Medicare Advantage Open Enrollment Period (OEP). This runs from January 1 to March 31 each year. You can’t use this OEP unless you’re currently a Medicare Advantage member, however.

There are many Medicare resources in New Jersey that you can use to help you find and compare Medicare Advantage plans. For example, the State Health Insurance Assistance Program (SHIP) offers free advice and counseling. Your local Area Agency on Aging is another good source of information. New Jersey Medicare brokers often have more detailed information about the plans and networks available in your area. 

With all the plan options and free resources available in New Jersey, it’s easy to find the best Medicare Advantage plans to meet your healthcare needs.