Medicare is the federal health insurance program for:

• People over 65
• Some younger people with disabilities
• People with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Medicare coverage is divided into four parts: Part A, Part B, Part C, and Part D. Different parts of Medicare cover different services. Some people get Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) automatically, and others have to sign up. In most cases, it depends on whether you are receiving Social Security benefits.

If you do not receive Social Security or Railroad Retirement Board benefits at least 3 months before your 65th birthday, you will need to enroll in Social Security to get Part A and Part B. Coverage B, you can deny it. However, if you decide to enroll in Part B later, you may have to pay a late enrollment penalty for as long as you have Part B coverage. While costs vary, Medicare generally pays 80 percent of the cost for services. covered, while you are responsible for the remaining 20 percent plus any required coinsurance or deductible for each benefit period.

Medigap

When an elderly or disabled individual is not covered by an employer or union health care plan, it is possible to purchase a supplemental policy to help close the gaps in original Medicare coverage. These policies are called Medigap insurance.

Medigap policies must follow federal and state laws and are standardized, so you can compare them. Standardized policies cover copayments for certain benefits.

Medigap policies may also offer additional benefits, such as hospital deductible coverage, at an additional cost. Medicare does not pay for any of the costs of a Medigap policy. To buy a Medigap policy, you must be enrolled in Medicare Part A and Medicare Part B. For a list of Medigap plans available in New Jersey, visit:

https://www.state.nj.us/humanservices/doas/services/ship/index.html

When to apply for Medicare: You must enroll in Medicare three months before your 65th birthday, even if you are not ready to start receiving retirement benefits. During your Medicare application, you can choose not to receive cash retirement benefits and you will always have the option to apply later.

How to apply for Medicare

Online at https://www.ssa.gov/benefits/medicare/

o Call Social Security at 1-800-772-1213 or visit your local Social Security office. Find a list of local offices here: https://secure.ssa.gov/ICON/main.jsp

Do you need help paying for your Medicare Part B premiums?

New Jersey offers assistance with Medicare Part B premiums to people who meet income and asset guidelines. If you also have NJ FamilyCare, your Medicare Part B premium can be paid through the Qualified Medicare Beneficiary (QMB) program. If you are not eligible for NJ FamilyCare, you may be eligible for Part B premium assistance through the Specific Low Income Medicare Beneficiary (SLMB) program. The SLMB program pays partial or full Medicare Part B premiums for eligible participants. Eligibility for SLMB:

Must be a New Jersey resident

• Must not be financially eligible for the Qualified Medicare Beneficiary (QMB) program under NJ FamilyCare
• You must not exceed the income or asset eligibility limits:
• SLMB - $ 17.232 * for singles and $ 23.280 * for married couples +
• Liquid assets cannot exceed $ 7,860 * for single individuals or $ 11,800 * for married couples.

* Reflects 2020 limits

Medicare coverage at a glance

• Part A: (Hospital Insurance) Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
• Part B: (Medical insurance) Covers certain medical services, outpatient care, medical supplies, and preventive services.
• Part D: (Prescription drug coverage) Covers medically approved pharmaceuticals. Monthly costs vary by plan.

Medicare Advantage (also known as Part C) is an all-in-one managed care alternative to original Medicare. These plans include Part A, Part B, and usually Part D, and are generally purchased for a monthly premium. Several companies offer Medicare Advantage plans at different costs and levels of coverage. The choice is yours. (Hospital Insurance) Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Federally Qualified Health Centers (FQHC)

Federally Qualified Health Centers (FQHCs) are community programs that provide primary and preventive health care, regardless of the patient's ability to pay. To find an FQHC in New Jersey, visit https://www.njpca.org/locate-center/

New Jersey Hospital Care Payment Assistance Program (Charity Care)

Charity Care is a payment assistance program available to uninsured and underinsured patients for inpatient and outpatient services at all acute care hospitals in New Jersey. Patients who meet the criteria for income and assets can receive medically necessary services at reduced rates or free. Eligibility is determined at the hospital where the medical service is provided when the completed application is submitted.

For more information: 1-866-588-5696

For Spanish: 609-292-4715

Pharmaceutical Assistance for the Elderly and Disabled (PAAD)

The Pharmaceutical Assistance for the Aged and Disabled (PAAD) program is a state-funded program that helps eligible older adults and people with disabilities save money on their prescription drug costs.

Eligibility for PAAD:

• You are a resident of New Jersey;
• Are age 65 or older or age 18 to 64 and receive Social Security Title II disability benefits; and
• Your 2020 annual income is less than $ 28,399 if you are single or less than $ 34,817 if you are married.
• PAAD beneficiaries eligible for Medicare must also enroll in a prescription drug plan. PAAD will pay the monthly premium for certain standard basic Part D plans with a monthly premium equal to or less than the regional benchmark, or standard basic plans or enhanced plans up to $ 20 above the reference amount that have no deductible. These plans will cover medically necessary prescription drugs under Medicare Part D. The federal Medicare plan and / or PAAD will pay for costs in excess of the PAAD copayment of $ 5 for each covered generic drug or $ 7 for each covered brand name drug, including premiums. However, if a Medicare Part D plan does not pay for a drug because the drug is not on their formulary, PAAD beneficiaries will have to switch to a drug on their Part D plan formulary, or their doctor will have to request an exception due to medical necessity directly from your Part D plan.
• Medicare Advantage participants must add a prescription drug benefit to their coverage, and PAAD will contribute up to the regional reference amount toward the prescription drug portion of their total premium.

NJ Medical Marijuana Program

The New Jersey Medical Marijuana Program allows patients with specific conditions to be certified by a physician to receive medical marijuana products for medical use. People interested in participating in the program should speak with their doctor or a doctor who participates in the program. Physicians are responsible for establishing good faith relationships with their patients, conducting a comprehensive patient assessment, certifying medical marijuana use, and determining the amount to be obtained within a given certification period. There is a $ 100 registration fee for patients and caregivers. Reduced rates of $ 20 are available to veterans, seniors, and people receiving government assistance.

For more information: (609) 292-0424 https://www.nj.gov/health/medicalmarijuana/