New Jersey Medicare insurance offers more affordable health insurance for those who are at least 65 years old, although working individuals with certain disabilities may be eligible as well. The cost of Medicare is much more manageable, as the premiums are much lower than other health insurance plans in the state. In New Jersey, the average cost of premiums is $591 per month.
The basic coverage comes from Original Medicare, with its two parts. Medicare Part A covers inpatient care and other hospital services, while Medicare Part B covers medically necessary treatments, supplies, and preventive screenings.
Medicare Part A does not usually require the payment of a premium, though there are exceptions. Medicare Part B does generally require a premium, but this depends on the annual income of the beneficiary. For those whose annual income does not exceed $85,000, the Part B premium is normally just $134 a month.
Both Part A and Part B also require beneficiaries to cover out-of-pocket expenses. These include the deductibles, copays, and coinsurance costs.
Original Medicare coverage may not be comprehensive enough for some Medicare beneficiaries, and to cover these gaps they can obtain supplemental plans for additional coverage. These plans are available from private health insurance companies with Medicare approval. These plans will also require an additional premium.
The coverage of these plans can vary. The most common type covers Medicare prescription drugs, and this is called Medicare Part D. Other plans may cover health care services that aren’t covered by Original Medicare, or they may cover the out-of-pocket expenses associated with Medicare Part A and Part B.
This refers to the Medicare Advantage Plans, which offers a comprehensive plan that merges the benefits of Original Medicare and the supplemental plans. Thus, the beneficiary of a Medicare Advantage Plan can receive Part A and Part B coverage, and other services not covered by Original Medicare may be covered instead. These plans may also include Medicare Part D coverage for prescription drugs.
These plans are also obtainable from private carriers which have been approved by Medicare.
These are the programs that New Jersey offers to help low-income state residents to pay for Medicare expenses. There are 3 of these MSPs and they offer varying degrees of assistance depending on the income and assets of the Medicare beneficiaries. The home and one vehicle of the beneficiary do not count as assets.
The first MSP is for Qualified Medicare Beneficiaries (QMB), and it pays for the Medicare Part B premium along with the Medicare deductibles and coinsurance. To qualify, an individual cannot earn more than $1,012 a month and have assets worth $4,000 at the most. Married couples have a combined income limit of $1,372 a month, and their assets cannot exceed $6,000 in value.
The Specified Low-Income Medicare Beneficiary (SLMB) and the Qualified Individual (QI-1) programs cover the premium for Medicare Part B only. Individuals have an income limit of $1,366 a month and an asset ceiling of $7,560. For couples, the limit is a monthly income of $1,852 and assets worth $11,340.
In New Jersey, qualifying for the MSPs also automatically enrolls the beneficiary in the Low-Income Subsidy (LIS) program. This can pay some or all of the costs of Medicare Part D. An individual can qualify with a monthly income of less than $1,518 and total assets worth less than $14,100. For a couple, the combined income cannot exceed $2,058 a month while their assets cannot be worth more than $28,150.
New Jersey also funds a prescription assistance program called Pharmaceutical Assistance to the Aged and Disabled (PAAD). This program pays for the Medicare Part D premium and all the “wrap-around” costs during the Part D deductible, co-insurance and “donut-hole” phases. The PAAD program also offers a copay rate of $5 for generic drugs and $7 for branded drugs. The beneficiary can choose to pay the PAAD or Medicare Part D copay, whichever is more affordable.
For PAAD, there is no resource limit. The income limit for individuals is $27,189 per year, while couples can qualify with a combined income of less than $33,334 per year.
New Jersey runs a State Health Insurance Assistance Program, which offers free and unbiased counselling services for state residents. Medicare beneficiaries can have their questions answered by calling SHIAP at 1-800-792-8820.
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