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Medicare Part D Coverage in New Jersey

Original Medicare (Part A and Part B) does not include prescription drug coverage. To get coverage, you need to add Medicare Part D to Original Medicare or purchase a Medicare Advantage Prescription Drug Plan. Learn more about your options, so you will know how to get prescription drug coverage.

Medicare Part D Coverage in New Jersey for Original Medicare

Original Medicare (Part A and Part D) offers minimal prescription coverage. If you receive medications at a skilled nursing facility or while in the hospital, Medicare Part A will cover the costs. If you receive vaccines, infusions, or another medication you cannot administer yourself, Medicare Part B will cover the costs. Original Medicare will not cover the costs you accrue from the medications you take at home.

If you want coverage for those medications, you will need to enroll in Medicare Part D coverage in New Jersey. These plans are not issued by the government. Instead, the government approves certain private insurers to offer the plans.

Once purchased, Medicare Part D works alongside Original Medicare. The plan will be separate from Original Medicare, but it will cover many of the medications you take at home. You can look at the formulary before purchasing coverage to find out which medications the plan will cover.

Medicare Advantage Prescription Drug Plans

You also have the option of getting prescription drug coverage through a Medicare Advantage (Medicare Part C) plan. At a minimum, Medicare Advantage plans must provide the same coverage as Original Medicare. Many offer additional benefits, though, such as prescription drug coverage. Plans with prescription drug coverage are called Medicare Advantage Prescription Drug Plans.

Like Medicare Part D coverage in New Jersey, Medicare Advantage plans are offered by private insurers. Insurers set the price for these plans.

How to Enroll in Medicare Part D Coverage in New Jersey

To enroll in Medicare Part D, you must have Medicare Part A and/or Part B. You also need to enroll during an enrollment period and live in an eligible service area.

Enroll during the:

  • Initial Enrollment Period (IEP) for Part D
    • If you are enrolling when you turn 65, the IEP starts three months before you turn 65 and ends three months after. You can get Medicare Part D during this time.
    • If you are enrolling in Medicare and Medicare Part D early due to a disability, your IEP starts three months before your 25th month of receiving disability benefits and ends three months after.
  • Annual Election Period
    • The Annual Election period runs from Oct. 15 to Dec. 7. During this period, you can make changes to your existing Medicare plan. That includes signing up for Medicare Part D.
  • Medicare Advantage Disenrollment Period
    • The Medicare Advantage Disenrollment Period lasts from Jan. 1 to Feb. 14. You can disenroll from Medicare Advantage and enroll in Original Medicare during this time. Once you enroll in Medicare, you can also enroll in Medicare Part D.
  • Special Election Period
    • A Special Election Period is available if you meet certain criteria, such as losing Medicaid eligibility or moving out of your plan’s service area. If you meet the criteria, you can add Medicare Part D coverage to your plan. If you are not sure if you’re eligible for a Special Election Period, speak to a licensed insurance agent.

Enrolling in Medicare Part D

The federal government will penalize you if you do not have Medicare Part D or creditable prescription coverage for a set period of time. Failure to have coverage for 63 or more days after the IEP can lead to a penalty. The penalty will be charged if you enroll in Medicare Part D at a later date.

The penalty is calculated by multiplying 1 percent of the national base beneficiary premium by the number of months that you went without coverage. The premium can go up each year, but it is $33.19 in 2019. After the penalty is calculated, it will be rounded up to the nearest $0.10 and added to your premium for Medicare Part D.

Get Help Selecting Medicare Part D Coverage in New Jersey

Prescription drug coverage can help you save quite a bit of money on healthcare expenses but choosing the right coverage can be challenging. Call 844-903-4406 to get help from a licensed insurance agent and determine whether Medicare Part D coverage in New Jersey or a Medicare Advantage Prescription Drug Plan is right for you. The agent will go over the formularies and benefits so you can make an informed decision.


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