Your Essential Guide to New Jersey Medigap Plans

Original Medicare covers a lot, but the remaining 20% you’re often responsible for can add up quickly, especially after a hospital stay or major procedure. That’s why Medigap plans exist. They act as a secondary insurance to cover your share of the costs, like copayments and deductibles. With a Medigap plan, you can virtually eliminate surprise medical bills. The key is finding the right balance between monthly premium and out-of-pocket costs. In this guide, we’ll compare the most common New Jersey Medigap plans, including popular options like Plan G and Plan N, to help you decide which one offers the right level of protection for you.

Key Takeaways

Focus on Price, Not Just the Plan Letter: Since all Medigap plans of the same letter (like Plan G) offer identical benefits regardless of the insurer, your main task is to compare monthly premiums. Shopping around is the most effective way to find the best value for your coverage.
Use Your One-Time Enrollment Window Wisely: Your six-month Medigap Initial Enrollment Period is the best time to sign up. During this window, you have guaranteed issue rights, meaning companies can’t deny you coverage or charge more for pre-existing health conditions.
Match Your Coverage to Your Needs: Consider your health and financial situation to find the right fit. A comprehensive plan like Plan G offers peace of mind with minimal out-of-pocket costs, while a plan like Plan N provides lower premiums in exchange for small, predictable copays.

What Are New Jersey Medigap Plans?

If you’re new to Medicare, you’ve probably heard the term “Medigap” and wondered what it means. Let’s clear it up. Medigap plans, also known as Medicare Supplement plans, are extra insurance policies you can buy from private companies. Think of them as a helper for your Original Medicare (Part A and Part B). Their job is to fill in the financial “gaps” that Original Medicare doesn’t cover, like deductibles and coinsurance. This can make your healthcare costs much more predictable and save you from surprise bills down the road.

What Medigap Covers

So, what exactly do these plans cover? Medigap policies are designed to help pay for your share of the costs after Original Medicare has paid its portion. While the specifics vary from plan to plan, all Medigap plans in New Jersey offer a set of core benefits. This includes paying for your Part A coinsurance for hospital stays, your Part B coinsurance and copayments for doctor visits, and the first three pints of blood you might need for a medical procedure. By covering these out-of-pocket expenses, a Medigap plan can provide peace of mind and financial stability, letting you focus on your health instead of worrying about costs.

Which Plans Are Available in New Jersey?

In New Jersey, you have several standardized Medigap plans to choose from. These plans are labeled with letters (like Plan G or Plan N) to make them easy to compare. While there are 10 different plan types available, a few are especially popular. Plan G is a top choice for new Medicare members because it offers very comprehensive coverage. Plan F provides the most coverage of all, but it’s only available if you were eligible for Medicare before January 1, 2020. Plan N is another favorite, offering lower monthly premiums in exchange for some small copays for doctor and emergency room visits. Understanding these key differences is the first step to finding the right fit for your needs.

How Medigap Works with Original Medicare

It’s important to remember that a Medigap plan works alongside your Original Medicare—it doesn’t replace it. You must be enrolled in both Medicare Part A and Part B to purchase a Medigap policy. When you receive medical care, Medicare pays its approved amount first. Then, your Medigap plan steps in to pay its share of the remaining costs, like your deductible or coinsurance. Another key rule is that you can’t have both a Medigap plan and a Medicare Advantage plan at the same time. You have to choose one path or the other.

Common Medigap Misconceptions

Let’s clear up a couple of common points of confusion. First, you may have heard about Plans C and F, which were popular for covering the Part B deductible. A change in federal law means these plans are no longer available to people who became eligible for Medicare on or after January 1, 2020. If you were eligible before that date, you might still be able to buy one. Second, Medigap plans don’t cover everything. A major exclusion is prescription drugs. For that, you’ll need to enroll in a separate Medicare Part D plan to get coverage for your medications.

How to Compare Popular NJ Medigap Plans

Choosing a Medigap plan can feel like a big decision, but it gets much easier when you understand the most popular options. In New Jersey, Plans G, N, and F are common choices, each offering a different balance of coverage and cost. The key thing to remember is that the benefits for each plan letter are standardized. That means a Plan G from one company offers the same basic benefits as a Plan G from another—only the price and customer service will change. Let’s walk through the top contenders.

Plan G: Benefits and Features

For anyone new to Medicare, Plan G is often the most comprehensive option available. It covers nearly all the gaps in Original Medicare, including your Part A deductible and your 20% coinsurance for Part B services. The only major out-of-pocket cost you’ll have is the annual Part B deductible. Once you meet that, Plan G picks up the rest of the Medicare-approved costs for the year. Because the coverage is so robust, it’s a fantastic choice for peace of mind. While the basic benefits are identical across insurers, monthly premiums can vary. For example, a 65-year-old in Newark might pay anywhere from $155 to $165 per month depending on the company they choose.

Plan N: Coverage and Cost-Sharing

If you’re looking for a plan with lower monthly premiums than Plan G, Plan N is an excellent alternative. It offers solid coverage but asks you to share some of the costs. With Plan N, you’ll still be responsible for the annual Part B deductible. After that, you may have small copayments for certain doctor visits (up to $20) and emergency room visits (up to $50, waived if you’re admitted). This trade-off makes Plan N a more budget-friendly option. For that same 65-year-old in Newark, monthly premiums for Plan N could range from $105 to $115. It’s a great fit if you don’t mind small, predictable copays in exchange for significant savings on your monthly premium.

Plan F: Who Is Still Eligible?

You might hear people talk about Plan F as the “Cadillac” of Medigap plans because it covers everything, including the Part B deductible. However, there’s a catch: Plan F is only available to individuals who were eligible for Medicare before January 1, 2020. If you became eligible after that date, you won’t be able to purchase Plan F. For those who do qualify, it offers the most complete coverage available, leaving you with virtually no out-of-pocket costs for Medicare-approved services. If you had Medicare prior to 2020, you can still enroll in this plan and explore your options.

A Look at High-Deductible Options

For healthy individuals who want to keep their monthly premiums as low as possible, a high-deductible plan is worth considering. The most common option is the High-Deductible Plan G (HDG). With this plan, you pay a very low monthly premium—sometimes under $50. In exchange, you must first pay a set annual deductible out-of-pocket before your plan’s coverage kicks in. This deductible is separate from the standard Part B deductible. A high-deductible Medigap plan is a good strategy for those who want protection against major, catastrophic health costs but are comfortable covering routine expenses themselves to save on monthly payments.

Comparing Plans Side-by-Side

Since every company’s Plan G or Plan N offers the same fundamental coverage, your main task is to compare prices. The difference in monthly premiums for the exact same plan can be substantial from one insurance company to the next. Don’t assume the biggest name has the best price. Take the time to check with different insurance companies in your area to see what they cost. By shopping around, you can make sure you’re not overpaying for your coverage. This single step is the most effective way to secure a plan that fits both your healthcare needs and your budget.

Breaking Down Medigap Costs

Understanding what you’ll pay for a Medigap plan can feel a bit like solving a puzzle. While the government standardizes the benefits for each plan letter (meaning a Plan G from one company has the same basic benefits as a Plan G from another), the insurance companies themselves set the monthly premiums. This is why you can see a wide range of prices for the exact same coverage.

The price you pay is influenced by several key things, which we’ll get into below. Think of it this way: the plan itself determines your coverage, but factors like the insurance company, your location, and your age determine your monthly bill. The good news is that because the coverage is identical across companies for the same plan letter, you have the power to shop around for the best price without sacrificing benefits. Using Medicare’s official plan comparison tool is a great starting point to see what specific costs look like in your area. Getting a handle on these moving parts is the first step toward finding a plan that fits your budget and your health needs.

How Your Premiums Are Set

Insurance companies use a few different methods to price, or “rate,” their Medigap premiums, and this approach affects how your premium might change over time. The most common methods are community-rated, issue-age-rated, and attained-age-rated.

With community-rated plans, everyone in a specific area pays the same premium, regardless of their age. Issue-age-rated premiums are based on your age when you first buy the policy; they won’t go up just because you get older, though they can increase for other reasons like inflation. Attained-age-rated premiums are based on your current age, meaning your premium will increase as you get older. It’s important to ask which rating method a company uses so you can anticipate how your costs might change in the future.

Factors That Affect Your Premium

Several elements come together to determine your final monthly premium. The cost of Medigap plans can vary quite a bit based on the insurance company you choose, the specific plan you select (for example, Plan G versus Plan N), your age, and even your zip code. Some companies may also factor in your gender or whether you use tobacco.

It’s a crucial point to remember: while the benefits are standardized, the prices are not. An insurer in one part of New Jersey might charge more for the same plan than a competitor just a few towns over. This is why comparing prices from different companies is one of the most effective ways to find the best value for your Medigap coverage.

Find Out if You Qualify for Discounts

Many people don’t realize they might be eligible for discounts on their Medigap premiums. Insurance companies often offer ways to lower your monthly payment, but you usually have to ask. A common one is a household discount, which you may get if your spouse or another member of your household is also enrolled with the same company.

Other potential discounts include savings for being a non-smoker, paying your premium annually instead of monthly, or setting up automatic payments directly from your bank account. When you’re getting quotes, make it a point to ask each company what discounts they offer. A few small discounts can add up to significant savings over the course of a year.

Your Premium Payment Options

Once you’ve chosen a plan, you’ll need to pay your monthly premium directly to the private insurance company. Most insurers offer several convenient ways to pay. You can typically mail a check, but many people prefer the ease of automatic payments. You can often set up an electronic funds transfer (EFT) directly from your checking or savings account, which ensures you never miss a payment. Some companies may even let you pay by credit card.

As mentioned above, some insurers even offer a small discount for enrolling in automatic payments. Be sure to explore the payment options available with the company you’re considering to find the method that works best for you.

Simple Tips to Manage Costs

The single most effective way to manage your Medigap costs is to shop around. Since the benefits for each plan letter are identical from company to company, you can compare them based on price and the company’s reputation. Don’t just get one quote—get several. This allows you to see the full range of prices available to you and find the best deal.

Another great tip is to choose a plan that truly matches your healthcare needs and budget. If you’re in excellent health and don’t mind paying for some costs out-of-pocket, a plan with cost-sharing like Plan N or a high-deductible plan might save you money on premiums. The key is to find the right balance between a manageable monthly premium and predictable out-of-pocket costs.

When and How to Enroll

Timing is everything when it comes to signing up for a Medigap plan. Enrolling at the right moment ensures you get the best price and can’t be turned down for coverage. Missing this window can make it harder and more expensive to get a plan later. Let’s walk through the key enrollment periods so you know exactly when to act.

Your Initial Enrollment Period

Think of this as your golden ticket to Medigap. Your six-month Medigap Initial Enrollment Period starts on the first day of the month you are both 65 or older and enrolled in Medicare Part B. During this time, insurance companies cannot use your health history to deny you a policy or charge you more. You have the right to buy any Medigap plan sold in New Jersey. This is, without a doubt, the best and simplest time to enroll. Because this period only happens once, it’s a good idea to mark it on your calendar and start your research ahead of time so you’re ready to make a decision.

What Are Guaranteed Issue Rights?

“Guaranteed issue” is a protection that allows you to buy a Medigap policy without answering health questions. Your Initial Enrollment Period is the most common time you have these rights. Essentially, an insurance company must sell you a plan, regardless of any pre-existing conditions you may have. They can’t single you out for a higher premium based on your health history. These guaranteed issue rights are incredibly valuable because they disappear once your enrollment window closes. This protection is why we always encourage people to sign up for Medigap as soon as they are eligible for Medicare.

Special Enrollment Opportunities

What if you miss your initial window? Don’t worry, you might have another chance. Certain situations grant you guaranteed issue rights outside of your initial period. For example, if you joined a Medicare Advantage plan when you first became eligible for Medicare and decide to switch back to Original Medicare within the first year, you have a special right to buy a Medigap plan. Other qualifying events include losing employer-sponsored coverage that was supplementing Medicare or moving out of your Medicare Advantage plan’s service area. These special enrollment periods have specific rules and timeframes, so it’s important to understand if your situation qualifies.

The Role of Medical Underwriting

If you apply for a Medigap plan outside of your Initial Enrollment Period or a Special Enrollment Period, you’ll likely have to go through medical underwriting. This is a process where the insurance company reviews your medical history, including past and present health conditions. Based on this review, they can legally charge you a higher premium than someone with a clean bill of health. In some cases, they can even deny your application for coverage altogether. This is the main reason why timing your enrollment correctly is so critical—it allows you to bypass this entire process and secure your coverage without any hassle.

New Jersey’s Enrollment Guidelines

New Jersey has some unique rules that offer extra protection for certain residents. Specifically, the state ensures that individuals under 65 who are eligible for Medicare due to a disability can access a Medigap plan. Under state law, insurers must offer Medigap Plan D to these individuals without charging higher premiums because of their age. If you are under 50 and on Medicare due to a disability, Horizon Blue Cross Blue Shield of New Jersey is required to offer you Medigap Plan D. These state-specific provisions provide a crucial safety net for residents who might otherwise struggle to find affordable supplemental coverage.

How to Choose the Right Medigap Plan

With so many options, picking the right Medigap plan can feel like a huge task. But it doesn’t have to be. By breaking it down into a few manageable steps, you can find a plan that fits your health needs and your budget. Let’s walk through how to make a confident choice.

Assess Your Personal Healthcare Needs

First, take a moment to think about your health, both now and in the future. Do you have chronic conditions that require frequent doctor visits? Do you anticipate needing any surgeries? Your answers will help you decide how much coverage you really need. It’s a balancing act: think about how much you can afford for a monthly premium versus how much you might have to pay out-of-pocket for services. Some plans have lower premiums but higher deductibles and copays. A plan with a higher premium might save you money in the long run if it covers more of your medical bills, giving you more predictable costs.

Research Different Insurance Companies

Once you have an idea of which plan letter (like G or N) seems like a good fit, it’s time to see who offers it. In New Jersey, many different private insurance companies sell Medigap plans. Here’s the key thing to remember: the benefits for the same plan type are identical, no matter which company you choose. A Plan G from one company has the exact same medical benefits as a Plan G from another. Because of this, you can compare prices from different companies to find the best deal. Don’t just go with the first one you see; shopping around can save you a significant amount of money each month.

Check Company Ratings and Reviews

Price is important, but it isn’t everything. You also want an insurance company that is reliable and easy to work with. Before you commit, do a little homework on the company’s reputation. You can look at financial strength ratings from agencies like AM Best to make sure the company is on solid ground. You can also check for customer complaints with the National Association of Insurance Commissioners (NAIC). Reading reviews can give you a sense of how the company handles claims and treats its members. A company with a long history of stable rates and excellent customer service can provide valuable peace of mind.

Key Factors in Your Decision

As you compare your final options, keep a few key factors in mind. First, confirm the plan you want is available in your area. Next, look closely at the monthly premium and ask how it’s priced. Some premiums go up as you get older (attained-age rated), while others are based on the age you were when you bought the policy (issue-age rated). This can make a big difference in your costs over time. It’s also wise to ask about the company’s rate increase history. While no company can guarantee future rates, a history of steady, modest increases is a better sign than one with frequent, steep hikes.

Questions to Ask Before You Decide

Before you sign up, run through a final checklist of questions. Does the plan cover the services you expect to need, like doctor visits, hospital stays, and emergency care abroad? What is the process for filing a claim? Most importantly, are you enrolling during a period where your acceptance is guaranteed? If you wait until after your Medigap Open Enrollment Period, insurance companies can sometimes deny you coverage or charge you more based on your health. Asking these questions upfront ensures there are no surprises later and helps you feel confident in your choice.

New Jersey Medicare Resources

Figuring out Medicare can feel overwhelming, but you don’t have to do it alone. New Jersey provides several key resources to help you understand your options and make confident decisions. Here’s where you can turn for support and information.

Know Your Consumer Protections

Your most important protection is your Medigap Open Enrollment Period. This is a one-time, six-month window that starts when you’re 65 and enrolled in Medicare Part B. During this period, an insurance company cannot deny you Medigap coverage or charge you more based on your health history. It’s critical to act during this time because if you miss this window, you may not be able to buy a plan later, or it could cost more. This is your guaranteed chance to get the coverage you want.

Using the “Birthday Rule”

While some states have an annual “birthday rule,” New Jersey’s version is a specific trial right. If you join a Medicare Advantage plan when you first become eligible but decide it’s not for you within the first year, you can switch back to Original Medicare. When you do, you have a guaranteed right to buy a Medigap policy. This gives you a valuable safety net, allowing you to try a different path without losing your chance to get a Medigap plan if you change your mind.

Where to Find Free Counseling

For straightforward, unbiased information, the official source is your best starting point. You can always visit Medicare.gov to compare plans and get details directly from the federal government. If you prefer to talk with someone, you can call 800-MEDICARE. Their representatives provide factual information about how Medicare works, and their services are completely free. They can clarify rules and benefits, helping you build a solid foundation of knowledge before you make any decisions.

Who to Call for Help

For personalized, local assistance, New Jersey’s State Health Insurance Assistance Program (SHIP) is an excellent resource. SHIP offers free, one-on-one counseling with trained volunteers who can help you understand your Medicare choices and compare Medigap plans. Since they don’t sell insurance, their advice is completely impartial. They are dedicated to helping you find the best path for your specific situation, right in your own community.

Frequently Asked Questions

Why is the price for the same Medigap plan different depending on the insurance company? This is a great question because it gets to the heart of how to shop for a plan. While the government standardizes the medical benefits for each plan letter—meaning a Plan G from one company covers the exact same things as a Plan G from another—the insurance companies set their own monthly premiums. They compete on price, customer service, and financial stability. This is why it’s so important to compare quotes from several different companies to make sure you’re getting the best value.

What happens if I miss my six-month Initial Enrollment Period? Missing your Initial Enrollment Period can make getting a plan more difficult. This six-month window is your one guaranteed chance to buy any Medigap plan without having to answer health questions. If you apply later, insurance companies can generally require you to go through medical underwriting. This means they will review your health history and can charge you a higher premium or even deny your application based on pre-existing conditions.

Do Medigap plans cover my prescription drugs, dental, or vision care? This is a common point of confusion. Medigap plans are designed to supplement Original Medicare (Part A and Part B), so they only help pay for services that Original Medicare covers. They do not include coverage for prescription drugs. For that, you will need to enroll in a separate Medicare Part D plan. Routine dental, vision, and hearing services are also not covered by Medigap.

Can the monthly premium for my Medigap plan go up over time? Yes, it’s very likely that your premium will increase over time. These increases are typically due to inflation and rising healthcare costs. How much and how often your premium goes up can also depend on the way the insurance company prices its plans. Some companies base your premium on your current age, meaning it will increase as you get older. It’s always a good idea to ask an insurance company about its rate increase history before you enroll.

I’m healthy right now. Do I really need a Medigap plan? It’s smart to think about this, but enrolling when you’re healthy is actually the best strategy. Your Initial Enrollment Period gives you a guaranteed right to buy any plan, regardless of your health status. If you wait and your health changes down the road, you might not be able to pass medical underwriting to get a plan later. Securing a Medigap plan when you first become eligible protects you from unpredictable and potentially high medical costs in the future.