New Jersey Medicare Plans and Coverage: A 2026 Guide

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 (Plan D for those eligible on or after January 1, 2020) with no age surcharge if they apply within 12 months of enrolling in Part B, and it offers free, unbiased counseling through the State Health Insurance Assistance Program (SHIP).1,2 The most useful number to save first: New Jersey SHIP at 1-800-792-8820.3

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 medical care, including most outpatient services. Most people pay no Part A premium because they or a spouse paid Medicare taxes long enough while working, generally at least 10 years. 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.5,4 These figures are set federally and apply identically in New Jersey.

Original Medicare has no yearly limit on what you pay out of pocket unless you have supplemental coverage, such as a Medigap policy, Medicaid, or employer, retiree, or union coverage; a Medicare Advantage plan instead carries its own annual in-network cap.4 Here is how the two paths compare.

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 all medically necessary Part A and Part B services that Original Medicare covers except hospice, which Original Medicare keeps covering, 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.4 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. Standalone plan premiums are set by the private insurers and vary by plan, and each plan decides which drugs on its formulary go on which cost tiers, so the same drug can cost a different amount from one plan to the next and the right plan depends on the specific drugs you take.5,7 In 2026, each plan sets its own deductible, 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).8 If your income is limited, the federal Extra Help program (the Part D Low-Income Subsidy) can cut these costs; with Extra Help, the plan deductible is $0.9

Medigap in New Jersey

Medigap (Medicare Supplement) policies are sold by private insurance companies and work only with Original Medicare.10 The plans are standardized by letter, so every Plan G offers the same basic benefits whichever insurer sells it.11 Plans C and F can't be sold to people new to Medicare on or after January 1, 2020, and that is a two-part test: you are new only if you turned 65 on or after that date and also got Part A on or after it. So if you had Medicare through a disability or End-Stage Renal Disease (ESRD) before 2020, the ban doesn't apply to you, and if you were eligible before 2020 but haven't enrolled yet, you may still be able to buy Plan C or F.11 Plan G covers the same benefits as Plan F except the annual Part B deductible.12

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.12 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. If you became eligible on or after January 1, 2020 and are under age 50, guaranteed-issue access is to Plan D through the state's contracting carrier, currently Horizon Blue Cross Blue Shield of New Jersey; between 50 and 64, Plan D is guaranteed-issue with any New Jersey Medigap insurer serving your area. Either way, you must apply within 12 months of enrolling in Part B.1

One practical risk to weigh before choosing Medicare Advantage first: outside your one-time Medigap Open Enrollment Period, and without a guaranteed issue right, there's no guarantee an insurer will sell you a Medigap policy if you don't meet its medical underwriting requirements. Federal law does give you two 12-month "trial rights," and they are not the same. If you joined Advantage when you were first eligible for Medicare at 65, you can switch to Original Medicare within that first year and buy any Medigap policy sold by an insurer in New Jersey guaranteed-issue (Plan D or G rather than C or F if you were new to Medicare on or after January 1, 2020). If instead you dropped a Medigap policy to try Advantage for the first time, you can get that same policy back if the insurer you had still sells it; if it doesn't, you can buy Plan A, B, C, D, F, or G from an insurer in New Jersey (D or G in place of C or F if you were new to Medicare on or after January 1, 2020). Under either right, apply no earlier than 60 days before your Advantage coverage ends and no later than 63 days after.12 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 resource limits of $18,090 (individual) and $36,100 (married couple); the lower limits of $16,590 and $33,100 apply only if you report that none of your resources will go toward funeral or burial expenses. The income figures are for one- and two-person households, so the limit rises if you support family members who live with you, and some income doesn't count at all; apply rather than screening yourself out. Those income figures are the limits for the 48 contiguous states and DC, New Jersey included; Alaska and Hawaii are figured from higher poverty guidelines, so the Extra Help income limits run higher there.9 The Medicare Savings Programs help pay the Part B premium and, for the QMB level, the Part A and Part B deductibles, coinsurance, and copayments too (though not Part D drug copays); the 2026 federal resource standard is $9,950 (individual) and $14,910 (married couple). Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help. QI has to be reapplied for every year, and none of these federal figures is a hard cutoff, because states can effectively raise both the income and the resource limits by disregarding certain income and resources, so apply rather than rule yourself out.13 The Medicare Savings Programs are state-run programs administered through Medicaid.13 In New Jersey, to learn about them and apply, contact your county SHIP.2

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.14,15 For the Medicaid side, see our New Jersey Medicaid guide.

Medicare Enrollment Periods

When you sign up matters, and missing your window without an exception can mean late penalties, and the Part B and Part D penalties last as long as you have that coverage. Your first chance to enroll is your 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.16 If you delayed Part B and do not qualify for a Special Enrollment Period or a Medicare Savings Program, your premium rises 10% for each full 12-month period you could have had Part B but did not, and that penalty lasts as long as you have Part B; the Part D penalty likewise lasts as long as you have Part D, and generally does not apply if you had creditable drug coverage or you qualify for Extra Help.17 A SHIP counselor can map your exact dates.

If you're 65 or older and you (or your spouse) are still working, with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first. COBRA and retiree coverage do not count as coverage based on current employment, and if you are self-employed or your plan is not available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it does not, sign up at 65. This Special Enrollment Period does not apply if you are eligible for Medicare based on End-Stage Renal Disease (ESRD).18

How to Enroll in Medicare in New Jersey

Enrollment in Parts A and B runs through the Social Security Administration (SSA), not Medicare itself. If you are already getting Social Security benefits at least 4 months before you turn 65, you are enrolled in Parts A and B automatically; otherwise you sign up yourself.10

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 volunteer counselors, with counseling sites in all 21 counties; counselors do not sell, recommend, or endorse any insurance product, agent, company, or plan.2,3 They help with claims, with evaluating health insurance options, and with questions such as how to fill the gaps in Original Medicare and whether programs are available to help pay Medicare and prescription costs.2

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.