If you are turning 65 in New Jersey, you face one main decision: keep Original Medicare with a Medigap supplement, or take a Medicare Advantage plan. Original Medicare (Parts A and B) pairs with a standalone Part D drug plan; Medicare Advantage bundles it all through a private insurer's network. Medicare itself is federal, so the parts, the 2026 costs, and the enrollment rules are the same everywhere. What New Jersey changes is the help around that decision and the supplement market you buy into.
Two things set the state apart. New Jersey protects people who qualify for Medicare under 65 by disability, guaranteeing them a Medigap policy with no age surcharge, and it offers free, unbiased counseling through the State Health Insurance Assistance Program (SHIP). The most useful number to save first: New Jersey SHIP at 1-800-792-8820.
In This Guide
- Original Medicare in New Jersey: Parts A and B
- New Jersey Medicare Advantage plans (Part C)
- Medicare Part D drug coverage
- Medigap in New Jersey
- Help paying for Medicare
- If you have both Medicare and Medicaid
- Medicare enrollment periods
- How to enroll in Medicare in New Jersey
- Free Medicare help: New Jersey SHIP
Original Medicare in New Jersey: Parts A and B
Original Medicare is the federal program: Part A covers hospital care and Part B covers doctors and outpatient care. Most people pay no Part A premium because they earned it through at least 10 years of Medicare-covered work. In 2026, the standard Part B premium is $202.90 per month, the Part B annual deductible is $283, and after the deductible you pay 20% of the Medicare-approved amount for most Part B services. The Part A hospital deductible is $1,736 per benefit period.Centers for Medicare & Medicaid Services. (2026). 2026 Medicare Parts A & B Premiums and Deductibles. cms.gov. Retrieved Jun 22, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles These figures are set federally and apply identically in New Jersey.
Original Medicare has no annual cap on what you can spend out of pocket, which is why most people add either a Medigap supplement or choose a Medicare Advantage plan. Here is how the two paths compare.
| Original Medicare + Medigap + Part D | Medicare Advantage (Part C) | |
|---|---|---|
| Providers | Any doctor or hospital that takes Medicare, nationwide | The plan's network, usually local |
| Referrals / prior authorization | Generally none | Often required |
| Out-of-pocket cap | None on Original Medicare; Medigap covers most cost-sharing | Yes, an annual cap (up to $9,250 in-network in 2026) |
| Extra benefits (dental, vision) | Not included | Often bundled |
| Monthly premiums | Part B + Medigap + Part D | Often low or $0, plus Part B |
New Jersey Medicare Advantage Plans (Part C)
Medicare Advantage plans are offered by private insurers and bundle Parts A, B, and usually D, often with extras like dental or vision, in exchange for using the plan's provider network. Every plan must cover everything Original Medicare covers except hospice, and every plan caps your annual in-network out-of-pocket spending, federally limited to $9,250 for Part A and B services in 2026, with many plans setting it lower.Centers for Medicare & Medicaid Services. (n.d.). Compare Original Medicare & Medicare Advantage - Medicare.gov. medicare.gov. Retrieved Jun 23, 2026, from https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage New Jersey has a competitive Advantage market, especially in the dense northern counties. The trade-off is the same everywhere: lower or zero premiums and bundled benefits, against network restrictions and prior authorization. Check that your doctors and preferred hospitals are in a plan's network before enrolling, and see the "Medigap in New Jersey" section below for one risk of choosing Advantage first.
Medicare Part D: Prescription Drugs
Part D covers prescription drugs, sold as a standalone plan paired with Original Medicare or built into a Medicare Advantage plan. Each plan sets its own premium, formulary, and pharmacy network, so the right plan depends on the specific drugs you take. In 2026, a Part D plan's deductible can be no higher than $615, and once your out-of-pocket spending on covered drugs reaches $2,100 for the year, you pay $0 for covered drugs for the rest of the calendar year (the old "donut hole" coverage gap was eliminated in 2025).Centers for Medicare & Medicaid Services. (n.d.). How much does Medicare drug coverage cost?. medicare.gov. Retrieved Jun 24, 2026, from https://www.medicare.gov/health-drug-plans/part-d/basics/costs If your income is limited, the federal Extra Help program (the Part D Low-Income Subsidy) can sharply cut these costs.U.S. Social Security Administration. (n.d.). SSA POMS HI 03030.025 - Resource Limits for Subsidy Eligibility. secure.ssa.gov. Retrieved Jun 22, 2026, from https://secure.ssa.gov/poms.nsf/lnx/0603030025
Medigap in New Jersey
Medigap (Medicare Supplement) policies pay the deductibles and coinsurance Original Medicare leaves behind. The plans are standardized by letter, so a Plan G is the same coverage from any insurer, and only the price and service differ; Plan G is the most popular choice for people newly eligible to Medicare.Centers for Medicare & Medicaid Services. (2025). Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (CMS/NAIC, 2025) - Medicare.gov. medicare.gov. Retrieved Jun 23, 2026, from https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf
Two New Jersey points matter. First, your strongest window is the federal 6-month Medigap Open Enrollment Period that starts once you are both 65 and enrolled in Part B; during it, insurers cannot deny you or charge you more for your health history.Centers for Medicare & Medicaid Services. (2025). Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (CMS/NAIC, 2025) - Medicare.gov. medicare.gov. Retrieved Jun 23, 2026, from https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf New Jersey does not add an annual "birthday rule" switch right.State of New Jersey. (n.d.). Division of Aging Services. nj.gov. Retrieved May 31, 2026, from https://nj.gov/humanservices/doas/services/q-z/ship/ Second, and unusually, New Jersey protects beneficiaries under 65: people who get Medicare through disability are guaranteed access to a Medigap plan and cannot be charged a higher premium for being under 65. Under age 50, guaranteed-issue access is to Plan D through the state's contracted carrier; between 50 and 64, Plan D is guaranteed-issue with any New Jersey Medigap insurer.State of New Jersey. (n.d.). Division of Aging Services. nj.gov. Retrieved May 31, 2026, from https://nj.gov/humanservices/doas/services/q-z/ship/
One practical risk to weigh before choosing Medicare Advantage first: outside your one-time Medigap Open Enrollment Period, insurers in most situations can medically underwrite a Medigap application and deny you or charge more. Federal law does give you a 12-month "trial right" to switch back to Original Medicare and buy any Medigap policy guaranteed-issue if you joined Advantage when you first became eligible at 65, or if you dropped a Medigap policy to try Advantage for the first time.Centers for Medicare & Medicaid Services. (n.d.). Guaranteed issue rights - Medicare.gov. medicare.gov. Retrieved Jun 24, 2026, from https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights After that trial year passes, a later switch from Advantage to Medigap can be blocked by health underwriting, so weigh the decision carefully at 65.
Help Paying for Medicare
If your income and assets are limited, two kinds of help can cut your Medicare costs. The federal Extra Help program lowers Part D drug costs; in 2026 the full-benefit income limit is about $1,995 per month ($23,940 per year) for an individual and about $2,705 per month ($32,460 per year) for a married couple, with asset limits of $16,590 (individual) and $33,100 (married couple).U.S. Social Security Administration. (n.d.). SSA POMS HI 03030.025 - Resource Limits for Subsidy Eligibility. secure.ssa.gov. Retrieved Jun 22, 2026, from https://secure.ssa.gov/poms.nsf/lnx/0603030025 The Medicare Savings Programs help pay the Part B premium and, for the QMB level, all Medicare cost-sharing; the 2026 resource limit is $9,950 (individual) and $14,910 (married couple), and enrolling in any Medicare Savings Program automatically qualifies you for Extra Help.U.S. Social Security Administration. (2026). SSA - POMS: HI 00815.023 - Medicare Savings Programs Income and Resource Limits - 02/26/2026. secure.ssa.gov. Retrieved Jun 22, 2026, from https://secure.ssa.gov/poms.nsf/lnx/0600815023 New Jersey administers the Medicare Savings Programs through its Medicaid program; a SHIP counselor or your county office can screen you and help you apply.
If You Have Both Medicare and Medicaid
Some New Jerseyans qualify for both Medicare and New Jersey Medicaid (NJ FamilyCare). If you are one of them, Medicare pays first for covered care and Medicaid can help with premiums, cost-sharing, and services Medicare does not cover, including long-term care through New Jersey's Managed Long-Term Services and Supports (MLTSS) program. Dual-eligible special needs plans (D-SNPs) coordinate both.Centers for Medicare & Medicaid Services. (n.d.). Beneficiaries dually eligible medicare medicaid. cms.gov. Retrieved Jun 22, 2026, from https://www.cms.gov/files/document/beneficiaries-dually-eligible-medicare-medicaid.pdf For the Medicaid side, see our New Jersey Medicaid guide.
Medicare Enrollment Periods
When you sign up matters, and missing your window can mean lifelong penalties. Most people enroll during their 7-month Initial Enrollment Period, which runs from 3 months before the month you turn 65 through 3 months after. Each fall, Medicare Open Enrollment (October 15 to December 7) lets you change Advantage and Part D plans, and the Medicare Advantage Open Enrollment Period (January 1 to March 31) lets people already in an Advantage plan make one change.Centers for Medicare & Medicaid Services. (n.d.). Open Enrollment. medicare.gov. Retrieved Jun 23, 2026, from https://www.medicare.gov/health-drug-plans/open-enrollment If you delayed Part B or Part D without other qualifying coverage, late penalties can apply for as long as you have the coverage. A SHIP counselor can map your exact dates.
How to Enroll in Medicare in New Jersey
Enrollment runs through the Social Security Administration (SSA), not a private broker. If you already receive Social Security benefits when you turn 65, you are enrolled in Parts A and B automatically; otherwise you sign up yourself.Centers for Medicare & Medicaid Services. (n.d.). How do I sign up for Medicare?. medicare.gov. Retrieved Jun 23, 2026, from https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare
Enroll in Parts A and B through Social Security
Sign up online at ssa.gov or call the Social Security Administration at 1-800-772-1213 during your Initial Enrollment Period. If you are already receiving Social Security, this happens automatically.Centers for Medicare & Medicaid Services. (n.d.). How do I sign up for Medicare?. medicare.gov. Retrieved Jun 23, 2026, from https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare
Decide your path: Original Medicare or Medicare Advantage
Choose Original Medicare plus a Medigap supplement and a standalone Part D plan, or a single Medicare Advantage plan. This is the decision to get right during your 6-month Medigap Open Enrollment window.
Compare plans on the Medicare Plan Finder
Use the official Medicare Plan Finder to compare Advantage and Part D plans by your specific drugs, pharmacies, and doctors before you enroll.
Get free help if you want a second opinion
Call New Jersey SHIP at 1-800-792-8820 for unbiased, no-pressure counseling before you commit.
Free Medicare Help: New Jersey SHIP
You do not have to sort this out from insurance ads. New Jersey's State Health Insurance Assistance Program (SHIP) offers free, unbiased Medicare counseling through trained volunteers in all 21 counties, with no sales pressure and no ties to any insurer. They help with plan comparisons, enrollment, appeals, and the programs that help pay costs.State of New Jersey. (n.d.). Division of Aging Services. nj.gov. Retrieved May 31, 2026, from https://nj.gov/humanservices/doas/services/q-z/ship/
Frequently Asked Questions
What are my Medicare choices in New Jersey?
The same two main paths as everywhere: Original Medicare (Parts A and B) with an optional Medigap supplement and a Part D drug plan, or a Medicare Advantage plan that bundles coverage through a private insurer's network. Which is better depends on your doctors, your drugs, and how you weigh flexibility against cost.
How much does Medicare cost in New Jersey in 2026?
The federal figures apply in New Jersey: the standard Part B premium is $202.90 per month, the Part B deductible is $283 for the year, and the Part A hospital deductible is $1,736 per benefit period. Medicare Advantage and Part D premiums are set by each plan and vary. Higher-income beneficiaries pay more for Parts B and D.
Does New Jersey let people under 65 buy Medigap?
Yes, and it is a real advantage. New Jersey guarantees under-65 disabled Medicare beneficiaries access to a Medigap plan with no age-based premium surcharge. Under 50, that is Plan D through the state's contracted carrier; ages 50 to 64, Plan D with any New Jersey Medigap insurer.
How do I get free help choosing a Medicare plan in New Jersey?
Call New Jersey SHIP at 1-800-792-8820. It is the State Health Insurance Assistance Program, run through the Division of Aging Services, and it offers free, unbiased counseling in all 21 counties with no sales pressure.
Can I get help paying for Medicare if my income is low?
Yes. The federal Extra Help program lowers Part D drug costs, and the Medicare Savings Programs help pay Part B premiums and cost-sharing. New Jersey runs the Medicare Savings Programs through Medicaid; a SHIP counselor can screen you.
When should I enroll in Medicare?
Most people enroll during the 7-month Initial Enrollment Period around their 65th birthday. Delaying Part B or Part D without other qualifying coverage can trigger lifelong late penalties, so check your dates with SHIP if you are unsure.
Learn More
Find personalized help comparing your New Jersey Medicare options at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.