Jane Dotson
Medicare is a federal health insurance program for individuals aged 65 and older. If you are under 65, you may still be eligible for Medicare if you have a disability, End-Stage Renal Disease (ESRD), or Lou Gehrig's Disease (ALS). To apply for Medicare in New Jersey, you can sign up online, call Social Security at 1-800-772-1213, or visit your local Social Security Office. New Jersey also offers Medicare Part B premium assistance to eligible individuals through the Medicare Savings Program (MSP). This program helps low-income seniors and individuals with disabilities save money on Medicare premiums, prescription costs, and other living expenses. Additionally, free Medicare counseling services are provided through the State Health Insurance Assistance Program (SHIP), where trained volunteers can help you navigate the system and find suitable options.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare in New Jersey? | People aged 65 and older, and certain younger people with disabilities and health conditions. |
| How to apply for Medicare in New Jersey | Sign up online, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778 for deaf or hard-of-hearing people), or visit your local Social Security Office. |
| What is Medicare Part A? | Hospital Insurance – Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. |
| What is Medicare Part B? | Medical coverage – Covers certain doctors’ services, outpatient care, medical supplies, and preventive services. |
| What is Medicare Part C? | Medicare Advantage – is an all-in-one managed care alternative to original Medicare. These plans include Part A, Part B, and usually Part D, and are typically purchased through a monthly premium. |
| What is Medicare Part D? | Covers prescription medications. |
| What is the Initial Enrollment Period for Medicare? | Begins 3 months before turning 65 and ends 3 months after the month you turn 65 – a total of 7 months. |
| What if I miss the Initial Enrollment Period? | You may have to pay a penalty if you enroll after this period. |
| What if I am still working after age 65? | You can apply online for Medicare only, or you may be able to wait until you retire to sign up during a special enrollment period. |
| What if I have a disability? | You may be eligible for Medicare if you have permanent kidney failure, End-Stage Renal Disease (ESRD), Lou Gehrig's Disease (ALS), or if you receive Disability benefits. |
| What is the NJ WorkAbility Program? | Offers full New Jersey Medicaid health coverage to working individuals with disabilities who would otherwise be ineligible due to income. |
| What is the Medicare Savings Program (MSP)? | Offers financial assistance for Medicare Part B premiums to individuals who meet income and asset guidelines. |
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What You'll Learn
Medicare Part A and Part B
If you are a retired member or dependent who qualifies for state-paid, post-retirement medical benefits and are eligible for Medicare, you must enrol in both Parts A and B. If you are already receiving Social Security retirement benefits, you will be automatically enrolled in both parts. You will receive a package in the mail three months before your 65th birthday with your new Medicare card. If you are 65 but are not receiving Social Security retirement benefits, you will need to actively enrol in Medicare. You should sign up for Medicare approximately three months before turning 65 by visiting www.socialsecurity.gov or by calling Social Security at 800-772-1213.
Once you receive your Medicare card, you must send a copy of the card to the Division of Pensions and Benefits to show proof of enrolment in Parts A and B to continue receiving post-retirement medical benefits without interruption. If you do not send proof of enrolment before becoming eligible for Medicare, your health benefits could be temporarily terminated.
If you have low income and low resources, you may qualify for a Medicare Savings Program (MSP) to help pay for your Part B premium, copayments, and deductibles. New Jersey offers three Medicare Savings Programs: The Qualified Medicare Beneficiary (QMB) program helps people with a countable income of up to $1,305 per month if living alone. The Specified Low-Income Beneficiary (SLMB) program helps people with a countable income of up to $1,565 per month if living alone.
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Eligibility requirements
To be eligible for Medicare in New Jersey, you must meet certain requirements. Firstly, Medicare is typically for individuals aged 65 or older. However, if you are under 65, you may still be eligible for Medicare if you have a qualifying disability. Specifically, you may qualify for early Medicare if you have End-Stage Renal Disease (ESRD), also known as permanent kidney failure, or Lou Gehrig's Disease (ALS). If you have one of these conditions, you will be eligible for Medicare Parts A and B immediately upon enrolling in Social Security disability benefits.
For those aged 65 or older, there are a few different paths to enrolling in Medicare, depending on your specific circumstances. If you begin receiving Social Security retirement benefits between the ages of 62 and up to 4 months before turning 65, you will be automatically enrolled in Medicare Parts A and B when you turn 65. On the other hand, if you apply for Social Security 3 months before you turn 65 or later, you can sign up for Medicare when you apply for Social Security.
The Initial Enrollment Period for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65, giving you a total of 7 months to sign up. If you miss this Initial Enrollment Period, you may have to pay a penalty. Additionally, if you are still working at age 65 and are not yet ready to receive Social Security benefits, you can apply online for Medicare only during a special enrollment period.
It's important to note that Medicare has different parts, and your eligibility for each part may vary. Medicare Part A covers hospitalization, home or skilled nursing, and hospice care, while Part B covers medical insurance. You may be eligible for premium-free Part A if you qualify for or are already receiving retirement or disability benefits from Social Security. For Part B, you will typically pay a monthly premium, even if you don't use any Part B-covered services.
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Enrollment process
Medicare is the federal health insurance program for individuals aged 65 and older. If you are under 65, you may be eligible for Medicare if you have a permanent disability, End-Stage Renal Disease (ESRD), or Lou Gehrig's Disease (ALS).
The enrollment process for Medicare in New Jersey is as follows:
- Initial Enrollment Period: The Initial Enrollment Period to sign up for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65—a total of 7 months. If you miss this period, you may have to pay a penalty.
- Automatic Enrollment: If you begin receiving Social Security retirement benefits between age 62 and up to 4 months before turning 65, you will be automatically enrolled in Medicare Part A and Part B when you turn 65.
- Online Enrollment: You can enroll online for Medicare Parts A and B, or Part A only at www.socialsecurity.gov. This is the easiest and fastest way to sign up and get any financial help you may need. You will need to create a secure my Social Security account to sign up for Medicare or apply for benefits.
- Phone Enrollment: You can also enroll by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778). If you are deaf or hard of hearing, call TTY +1 800-325-0778.
- In-Person Enrollment: You can visit your local Social Security Office to apply for Medicare.
- Special Circumstances: If you have Lou Gehrig's Disease (ALS), you will receive Medicare Parts A and B immediately when you enroll in Social Security disability benefits. If you have ESRD, you can call 800-772-1213 and tell the representative you want to apply for Medicare because you have ESRD.
- Medicare Savings Programs: New Jersey offers Medicare Part B premium assistance through Medicare Savings Programs (MSPs), which help low-income seniors and individuals with disabilities save money on Medicare premiums, prescription costs, and other living expenses.
- Free Counseling Services: New Jersey provides free Medicare counseling services through local State Health Insurance Assistance Program (SHIP) offices. Trained volunteers can help you navigate the system and find the right options for you.
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Medicare Savings Programs
In New Jersey, the Division of Aging Services (DoAS) manages Medicare Savings Programs, aiming to help low-income seniors and individuals with disabilities reduce their Medicare premiums, prescription costs, and other living expenses. The NJ Save website provides online applications and resources, including application instructions and a video tutorial, to simplify the process for those seeking assistance.
To apply for Medicare Savings Programs, individuals must contact their respective states. Each state determines eligibility, and qualification criteria may vary. Generally, income and resource limits are considered, and some states exclude specific income or resource types from their calculations. It is recommended that individuals apply even if they are unsure about their eligibility, as some states offer flexibility in their qualification criteria.
It is important to note that Medicare Savings Programs are distinct from Medicaid, and individuals who qualify for Medicaid may not be eligible for these savings programs. However, other forms of assistance may be available, such as the Qualifying Individual (QI) program, which caters to those who do not qualify for Medicaid but need help with their Medicare expenses.
Additionally, Medicare Savings Programs may provide extra help with prescription drug costs. For instance, in 2025, individuals will pay no more than $12.15 per drug covered by their Medicare drug plan. This assistance is available to those with Original Medicare, who can present their Medicare card and claims statements to demonstrate their participation in the program.
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Medicare Advantage Plans
If you are eligible for Medicare, you can sign up for Medicare Advantage Plans through private insurance companies that offer them. One such company in New Jersey is Braven Health, which offers Medicare Advantage Plans in partnership with Horizon Blue Cross Blue Shield of New Jersey. Braven Health provides a large network of providers, flexible out-of-network benefit options, and exclusive member extras. They also offer $0 premium options and low out-of-pocket costs.
You can learn more about Braven Health's Medicare Advantage Plans by attending one of their online meetings, where you can ask questions and review their plan options. They also offer a free plan guide that can be requested via email or postal mail.
It is important to note that the Initial Enrollment Period for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65. If you miss this 7-month window, you may have to pay a penalty for late enrollment. Additionally, you can only sign up for Medicare Part B, the medical insurance component, at certain times. If you do not sign up for Part B when you are first eligible, you may have to pay a monthly late enrollment penalty.
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Frequently asked questions
You can apply for Medicare in New Jersey by signing up online, calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778 for deaf or hard-of-hearing users), or visiting your local Social Security Office.
Medicare is typically available for individuals aged 65 and over. However, certain younger people with disabilities and health conditions such as End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease (ALS) may also be eligible.
Yes, New Jersey offers the Medicare Savings Program (MSP), which provides premium assistance for Medicare Part B to individuals who meet income and asset guidelines. You can check your eligibility using the online application NJSave.
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