New Jersey Medicare Advantage plans offer an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. This comprehensive New Jersey Medicare Advantage guide covers available plan types, top carriers, star ratings, costs, enrollment periods, and how to decide whether Medicare Advantage or Original Medicare with Medigap is right for you. Whether you are turning 65, exploring options during Annual Enrollment, or helping a parent compare plans, understanding the New Jersey Medicare Advantage landscape helps you make the best decision.
All information verified against CMS data as of April 2026.
In This New Jersey Medicare Advantage Guide:
New Jersey Medicare Advantage Market Overview
| Total MA Plans Available | 85 |
| Total Medicare Beneficiaries | 1750000 |
| Enrolled in MA | 715000 |
| MA Penetration Rate | 41% |
| Most Common Plan Type | PPO |
Medicare Advantage Plan Types in New Jersey
Medicare Advantage plans in New Jersey come in several types:
- HMO (Health Maintenance Organization): Requires using in-network providers except in emergencies. Usually lower premiums. Often requires referrals to see specialists.
- PPO (Preferred Provider Organization): Allows out-of-network care at higher cost. No referrals needed for specialists. More flexibility but typically higher premiums.
- PFFS (Private Fee-for-Service): You can see any Medicare-approved provider that accepts the plan’s payment terms. Less common.
- SNP (Special Needs Plans): Designed for specific populations — dual-eligible, chronic conditions, or institutional care.
PPO plans are the most common type of Medicare Advantage plan in New Jersey.
Top Medicare Advantage Carriers in New Jersey
Top Medicare Advantage carriers in New Jersey by enrollment:
- UnitedHealthcare
- Braven Health
- Aetna
- Humana
- Clover Health
UnitedHealthcare has the largest Medicare Advantage enrollment in New Jersey.
New Jersey Medicare Advantage Costs
The average monthly premium for Medicare Advantage plans in New Jersey is approximately 25.23.
Many New Jersey MA plans offer $0 monthly premiums (you still pay your Part B premium).
Every MA plan has a Maximum Out-of-Pocket (MOOP) limit, which caps your annual spending on covered services. This is a key advantage over Original Medicare, which has no out-of-pocket cap.
CMS Star Ratings in New Jersey
CMS rates Medicare Advantage plans on a 1-5 star scale based on quality of care, member satisfaction, customer service, and other factors. When comparing plans in New Jersey, prioritize plans with 4 or more stars.
Extra Benefits Beyond Original Medicare
Most Medicare Advantage plans in New Jersey include benefits that Original Medicare does not cover:
- Dental, vision, and hearing: Most MA plans in New Jersey include dental cleanings, eye exams, and hearing aids.
- Prescription drug coverage (Part D): MOST Medicare Advantage plans in New Jersey include integrated Part D drug coverage.
- Fitness programs: Many plans include SilverSneakers or similar gym memberships.
- Transportation: Some plans cover rides to medical appointments.
- Meal delivery: Some plans provide meal delivery after hospital discharge.
- Over-the-counter allowance: Many plans provide quarterly OTC benefit cards for health supplies.
Special Needs Plans (SNPs) in New Jersey
Special Needs Plans are available in New Jersey for beneficiaries with specific health conditions or circumstances:
- D-SNP (Dual-Eligible): For people who qualify for both Medicare and Medicaid.
- C-SNP (Chronic Condition): For people with specific chronic conditions such as diabetes, heart failure, or ESRD.
- I-SNP (Institutional): For people living in nursing facilities or requiring an institutional level of care.
SNPs provide coordinated care tailored to your specific needs. Contact your local SHIP office to determine if a SNP is right for you.
Medicare Advantage vs Original Medicare in New Jersey
| Feature | Medicare Advantage | Original Medicare + Medigap |
|---|---|---|
| Monthly Premium | Often $0 (+ Part B premium) | Part B + Medigap ($100-300+/mo) |
| Out-of-Pocket Max | Yes (MOOP cap) | No cap on Original Medicare |
| Provider Network | Network required (HMO) or preferred (PPO) | Any Medicare-accepting provider nationwide |
| Drug Coverage | Usually included | Separate Part D plan needed |
| Extra Benefits | Dental, vision, hearing, fitness often included | Not included |
| Best For | Budget-conscious, healthy, urban areas | Frequent travelers, rural areas, chronic conditions |
Additional New Jersey Medicare Advantage regulations: Birthday Rule allows Medigap plan switching during birth month without health underwriting; Under-50 Medicare Supplement Program requires carriers to offer Medigap Plan C or D to disabled Medicare beneficiaries under 50; Guaranteed issue protections prohibit denial or discriminatory pricing based on health status; NJ operates a state-administered FIDE SNP (Fully Integrated Dual Eligible Special Needs Plan) program; Medicare Advantage plans are federally regulated by CMS but carriers must be licensed in NJ
New Jersey Medicare Advantage Enrollment Periods
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday. You can join an MA plan during this period.
- Annual Enrollment Period (AEP): October 15 through December 7. Switch between MA plans or return to Original Medicare.
- Medicare Advantage Open Enrollment Period (OEP): January 1 through March 31. Switch MA plans or drop MA and return to Original Medicare (and add a Part D plan).
- Special Enrollment Periods (SEP): Available for qualifying life events such as moving, losing employer coverage, or qualifying for Medicaid.
Compare New Jersey Medicare Advantage Plans
Ready to compare Medicare Advantage plans in New Jersey? The official Medicare Plan Finder lets you compare plans by cost, star rating, drug coverage, and extra benefits in your zip code.
Official Sources & Resources
- Medicare.gov Plan Finder: medicare.gov/plan-compare
- CMS Medicare Advantage Data: cms.gov
- New Jersey Department of Banking and Insurance (DOBI): https://www.nj.gov/dobi/
- KFF Medicare Advantage Data: kff.org
Last verified April 2026. Contact us if you notice outdated information.