Medicare in New Jersey: 2025 Guide
New Jersey is one of the few states with community rating protections for Medigap policies and a dedicated pharmaceutical assistance program — PAAD — that helps seniors with drug costs above what Medicare Part D covers. With approximately 1.7 million Medicare enrollees and a Medicare Advantage penetration of around 50%, New Jersey offers a highly competitive insurance market shaped in part by proximity to the New York and Philadelphia metro areas. The state's high cost of living is reflected in plan pricing, but the combination of community-rated Medigap and PAAD benefits gives New Jersey beneficiaries meaningful consumer protections.
New Jersey Medicare Quick Facts
| Medicare Enrollees | ~1.7 million |
| Medicare Advantage Penetration | ~50% |
| SHIP Program Name | NJ Apprise (State Health Insurance Assistance Program) |
| NJ Apprise Phone | 1-800-792-8820 |
| State Pharmaceutical Assistance | PAAD (Pharmaceutical Assistance to the Aged and Disabled) and Senior Gold |
| Medicaid Program | NJ FamilyCare (Medicaid expansion state) |
Medicare Advantage Plans in New Jersey
New Jersey's Medicare Advantage market is competitive, particularly in the northern counties bordering New York City (Bergen, Essex, Hudson, Union) and the southern counties near Philadelphia (Camden, Burlington, Gloucester). Insurers active in New Jersey include Horizon Blue Cross Blue Shield of New Jersey, UnitedHealthcare, Aetna, Humana, and Clover Health, among others.
MA penetration is approximately 50%, meaning roughly half of New Jersey Medicare beneficiaries choose Medicare Advantage while the other half remain on Original Medicare — many of the latter supplementing with Medigap. New Jersey's community rating rules make Medigap a more attractive option here than in states where premiums rise sharply with age.
New Jersey's high cost of living means MA plan premiums and out-of-pocket costs may run higher than national averages in some areas. Always compare the full cost picture — premiums, deductibles, copays, and network — before selecting a plan. NJ Apprise counselors can assist with plan comparisons at no cost. Learn more about Medicare Advantage →
Medicare Savings Programs in New Jersey
New Jersey administers Medicare Savings Programs through the NJ FamilyCare Medicaid program. As a Medicaid expansion state, New Jersey has broader eligibility than many non-expansion states, helping more low-income seniors qualify for premium and cost-sharing assistance.
The four MSP tiers in New Jersey:
- Qualified Medicare Beneficiary (QMB): Covers Part A and B premiums, deductibles, and cost-sharing — providers may not bill QMB enrollees for Medicare cost-sharing
- Specified Low-Income Medicare Beneficiary (SLMB): Pays the Part B premium ($185/month in 2025)
- Qualifying Individual (QI): Pays the Part B premium (limited annual funding, apply early)
- Qualified Disabled and Working Individuals (QDWI): Pays the Part A premium for certain disabled workers
To apply for an MSP in New Jersey, contact NJ FamilyCare at 1-800-701-0710 or visit njfamilycare.org. Your NJ Apprise counselor can also help with the application.
State Pharmaceutical Assistance: PAAD and Senior Gold
New Jersey operates two State Pharmaceutical Assistance Programs (SPAPs) that can significantly reduce out-of-pocket drug costs for eligible residents:
PAAD — Pharmaceutical Assistance to the Aged and Disabled
- Income limit: Approximately $42,000 for a single person (verify current limits with the program, as they are adjusted periodically)
- Benefit: Caps your copayment on covered drugs, paying the difference between your Part D cost-sharing and the PAAD cap
- Coordination: Works alongside Medicare Part D — you must have Part D to use PAAD
- Application: Apply through the NJ Division of Aging Services at 1-800-792-8820
Senior Gold
- Income limit: Slightly higher than PAAD — for those who earn too much for PAAD but still need drug cost assistance
- Benefit: Provides prescription drug discounts, though benefits are less comprehensive than PAAD
- Application: Apply through the same NJ Division of Aging Services contact as PAAD
Both programs coordinate with Medicare Part D and can dramatically reduce what New Jersey Medicare beneficiaries pay at the pharmacy. NJ Apprise counselors can help you determine which program you qualify for and assist with applications.
Getting Medicare Help in New Jersey: NJ Apprise
New Jersey's State Health Insurance Assistance Program is known as NJ Apprise. Funded federally and administered by the New Jersey Department of Health, NJ Apprise provides free, unbiased Medicare counseling through a statewide network of trained counselors.
NJ Apprise counselors can help you:
- Compare Medicare Advantage, Part D, and Medigap plans in your county
- Apply for PAAD, Senior Gold, Medicare Savings Programs, and Medicare Extra Help
- Understand New Jersey's community Medigap rating rules
- Resolve Medicare billing disputes and coverage problems
- Navigate the enrollment process during your Initial Enrollment Period or Annual Open Enrollment
Contact NJ Apprise:
- Phone: 1-800-792-8820
- Website: state.nj.us/health/apprise
- Local offices: NJ Apprise counselors operate through County Offices on Aging across all 21 New Jersey counties
Frequently Asked Questions: Medicare in New Jersey
New Jersey beneficiaries in the northern metro counties typically have access to 25–40 or more Medicare Advantage plans from insurers including Horizon BCBS NJ, UnitedHealthcare, Aetna, Humana, and Clover Health. Southern New Jersey counties near Philadelphia also have strong plan availability. Central and rural counties generally have somewhat fewer choices. Use Medicare.gov's Plan Finder with your specific zip code during Annual Open Enrollment (October 15 – December 7), or call NJ Apprise at 1-800-792-8820 for free plan comparison assistance.
PAAD (Pharmaceutical Assistance to the Aged and Disabled) acts as a secondary payer on top of your Medicare Part D plan. After your Part D plan pays its share, PAAD steps in to cover additional cost-sharing up to a capped copayment amount — meaning you may owe only a few dollars per prescription rather than the full Part D cost-sharing amount. To use PAAD, you must be enrolled in a Medicare Part D plan. Income limits are approximately $42,000 for a single person (verify current limits). The Senior Gold program covers those with somewhat higher incomes. To apply for either program, call NJ Apprise at 1-800-792-8820 or the NJ Division of Aging Services.
New Jersey requires community rating for Medigap (Medicare supplement) policies, meaning insurers must charge the same premium to all enrollees regardless of age or health status. Additionally, New Jersey law provides guaranteed issue rights for most Medigap plans on a year-round basis — you are not limited to buying Medigap only during your initial 6-month open enrollment window. This is a significant consumer protection: in most states, insurers can deny coverage or charge higher premiums if you try to buy Medigap after your initial window closes. In New Jersey, you can typically switch Medigap plans or buy one for the first time at any age without being subject to medical underwriting. Call NJ Apprise at 1-800-792-8820 for help comparing Medigap plans available to you.
Need Help with Medicare in New Jersey?
Call NJ Apprise at 1-800-792-8820 for free, unbiased Medicare counseling — or explore our national Medicare guides below.
Medicare Basics Guide → Medigap Guide