New Jersey's Medicare Regulations

Medicare health insurance in New Jersey provides coverage for those 65 and older. Younger people with certain disabilities also are eligible, and there is no age requirement for patients with permanent kidney failure who require dialysis or a kidney transplant. There are four parts to Medicare benefits, and each has its own criteria and covers specific services.

Help Navigating the Medicare System

• Understanding Medicare health coverage can be difficult. That's why the New Jersey Department of Health and Senior Services provides free assistance to help residents understand the ins and outs of Medicare, Parts A through D. The State Health Insurance Assistance Program, or SHIP, offers Medicare recipients one-on-one help with information about benefits and claims.

Broader Medical Coverage

• Medicare Part B covers such services as doctor visits, outpatient care, long-term in-home care and some preventive services. The standard monthly premium, which usually is deducted from your Social Security benefit check, ranges from $96.40 to $110.50, depending on when you enrolled. (Premiums are higher for higher-income people.) New Jersey will pay for part or all of your monthly premium if you meet certain income criteria. For example, if you are a single person with an income below $14,621 or a couple whose income is below $19,670, you could save at least $1,000 a year.

Full Medical and Prescription Coverage

• Medicare Advantage Plan, Part C, and Prescription Drug Coverage, Part D, are a combination of Parts A and B. The Advantage Plan offers you the option of enrolling in a Preferred Provider Organization or a Health Maintenance Organization. If you have difficulty paying for prescription premiums, New Jersey offers the Pharmaceutical Assistance to the Aged and Disabled program (PAAD). If you are enrolled in basic Medicare Part D, the state will pay the total cost of co-payments for generic prescriptions of $7 or less. For prescriptions that are not on Part D's formulary, you will have to switch to a medication that is, have your doctor request an exception, or apply for a federal subsidy.