New Jersey is a mid-size Medicare Advantage market with about 1.8 million Medicare beneficiaries and a 41% MA penetration rate, below the national average of roughly 54%. That lower penetration partly reflects the state's strong Medigap culture: New Jersey is one of a handful of states with consumer-friendly Medigap rules, including guaranteed-issue protections for disabled enrollees under 65, which make original Medicare plus a supplement a viable option for more residents.
The state has 85 MA plans in 2026, down from 92 in 2025 — see Medigap vs Medicare Advantage if you're weighing the Original Medicare track. Plan choice is concentrated in the northeastern urban corridor (Bergen, Essex, Hudson, Middlesex, Union), where 30 or more plans compete per county. Warren County, in the far northwest, has the fewest options statewide. Major carriers include Aetna, UnitedHealthcare, Braven Health (Horizon BCBS NJ's dedicated Medicare brand), Humana, Clover Health, and WellCare. Notably, Kaiser Permanente does not operate in New Jersey.
This guide covers the 2026 New Jersey Medicare Advantage market: how many plans, which carriers, what to compare when shopping, and the key enrollment windows. The Annual Election Period is October 15 to December 7, 2026, with coverage starting January 1, 2027.
2026 Medicare Advantage Market Overview in New Jersey
In 2026, New Jersey has 85 Medicare Advantage plans available, with 735,000 beneficiaries enrolled (41% MA penetration). The average monthly premium is $25 and the statewide average Star Rating is 3.8.
Top Medicare Advantage carriers in New Jersey (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Aetna | 13 | 4.2 | $18/mo |
| UnitedHealthcare | 11 | 4.5 | $14/mo |
| Braven Health | 7 | 4.0 | $22/mo |
| Humana | 5 | 3.8 | $12/mo |
| Clover Health | 8 | 3.5 | $8/mo |
| WellCare | 4 | 3.5 | $6/mo |
| Wellpoint | 3 | 3.0 | $0/mo |
| AmeriHealth | 3 | 2.5 | $10/mo |
Source: NerdWallet NJ Medicare Advantage 2026, MoneyGeek NJ MA 2026, CMS Medicare Plan Finder Q4 2025, CMS 2026 Star Ratings
Plan Types in New Jersey: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in New Jersey| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO / HMO-POS | 23 | $15/mo | Lower premiums, in-network care; HMO-POS adds some out-of-network flexibility |
| PPO | 55 | $30/mo | Flexibility to see out-of-network providers; no referrals required |
| Special Needs Plan (SNP) | 7 | $0/mo | Dual-eligible (NJ FamilyCare + Medicare), chronic conditions, or institutional care |
PPO plans dominate New Jersey's 2026 MA market, accounting for roughly 65% of all plans. $0-premium options exist across both HMO and PPO types.
Source: MoneyGeek NJ Medicare Advantage 2026, CMS Medicare Plan Finder
County-Level Variance in New Jersey
Plan availability varies by county in New Jersey. Urban counties in the northeastern corridor offer 30 or more plans; rural and western counties may offer fewer than 20. Premiums also differ, with densely populated areas seeing more $0-premium competition.
Plan count and average premium by county in New Jersey| County | Plans Available | Avg Premium |
|---|
| Bergen County | 36 | $28/mo |
| Essex County | 32 | $30/mo |
| Ocean County | 31 | $32/mo |
| Hunterdon County | 22 | $25/mo |
| Warren County | 12 | $20/mo |
Plan counts are approximate based on CMS Medicare Plan Finder Q4 2025 data. Run a ZIP-code search at medicare.gov for exact options in your area.
Source: CMS Medicare Plan Finder Q4 2025, medicareadvantage.com county data
What to Look For in a Medicare Advantage Plan in New Jersey
New Jersey's MA market has more PPO plans than most states, which changes how you shop. Here's what to focus on for 2026:
- Provider network. Confirm your primary care physician, specialists, and preferred hospital are in-network before enrolling. NJ hospital systems (RWJBarnabas, Hackensack Meridian, Atlantic Health) align with specific carriers, particularly Braven Health. Check each plan's provider directory.
- Prescription drug coverage (formulary). Most NJ MA plans include Part D. Check that your specific medications are on the plan's formulary at the tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all plans, set by the Inflation Reduction Act.
- Star Ratings. CMS rates plans 1-5 stars annually on care quality, member experience, and customer service. UnitedHealthcare has multiple 5-star plans in NJ for 2026, which carry a Special Enrollment Period that lets you switch into them any time of year. Aetna NJ plans average 4.2 stars.
- Maximum out-of-pocket (MOOP). The 2026 federal MOOP ceiling for in-network MA is $9,250 (down from $9,350 in 2025). NJ plans range from $2,900 to $9,250, with the most competitive plans setting limits of $4,000 to $6,700. Original Medicare has no annual MOOP cap.
- Supplemental benefits (dental, vision, hearing, fitness). Most NJ MA plans include some level of extras that Original Medicare does not cover. Scope varies widely: look for annual dental limits, covered procedures, and whether hearing aids are included before selecting a plan.
- Prior authorization. MA plans can require prior authorization for imaging, surgeries, and specialist visits. If you have ongoing care needs or a chronic condition, research how often your target plan requires prior auth and check CMS denial rate data.
- $0-premium vs total cost. Every NJ resident can find a $0-premium MA plan, but premium is only one part of cost. Add copays, deductibles, and your MOOP to estimate your realistic annual spend. A plan with a $25/mo premium and a $4,500 MOOP may cost less than a $0 plan with a $7,500 MOOP if you have moderate health care use.
Key Medicare Dates in New Jersey
Medicare has several enrollment windows. Missing them can mean waiting months or facing late enrollment penalties.
- Annual Election Period (AEP): October 15 to December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 to March 31, 2026 — Existing MA enrollees can switch to a different MA plan or return to Original Medicare. One switch only. No new enrollments from Original Medicare.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes your birth month, runs 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original Medicare plus Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area, losing employer coverage, qualifying for NJ FamilyCare (dual eligible), or other qualifying events. Typically a 2-3 month window per event.
- 5-Star Special Enrollment Period: December 8, 2026 to November 30, 2027 — If a plan in your area earns a 5-star CMS rating, you can switch into it once during this window. UnitedHealthcare has 5-star plans in New Jersey for 2026.
Notable Extras in New Jersey Plans
New Jersey has several market features that shape how Medicare Advantage works in the state:
- Braven Health and hospital-aligned plans: Braven Health is a joint venture between Horizon Blue Cross Blue Shield of New Jersey, Hackensack Meridian Health, and RWJBarnabas Health. It is the only NJ MA carrier whose network is built directly around two of the state's largest hospital systems. If your care is centered at Hackensack or RWJBarnabas facilities, Braven may offer the most integrated experience.
- NJ FamilyCare and dual-eligible D-SNPs: NJ FamilyCare is New Jersey's Medicaid program. If you qualify for both NJ FamilyCare and Medicare, you are dual eligible and can enroll in a Dual Special Needs Plan (D-SNP), which coordinates both programs into one plan with typically $0 premiums and $0 copays. Horizon NJ TotalCare (HMO D-SNP) is the primary option for dual-eligible NJ residents.
- NJ Medigap rules and the MA tradeoff: New Jersey provides stronger Medigap access than most states. Disabled Medicare beneficiaries under 65 have guaranteed issue rights for certain Medigap plans, a protection that most states do not offer. This means the choice between Medicare Advantage and Original Medicare plus Medigap is more balanced in NJ than in many other states. Weigh the total annual cost of each track for your situation before enrolling.
Medicare Advantage vs Original Medicare in New Jersey
Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D plan gives you access to any provider who accepts Medicare anywhere in the country, with no prior authorization requirement for most services. In New Jersey, Medigap plus Part D typically costs $200 to $400 per month in total premium, depending on the Medigap plan type and carrier. Medicare Advantage bundles hospital, medical, and usually drug coverage into one plan at an average of $25 per month in NJ, but limits you to a defined network and requires prior authorization for many services.
New Jersey is one of the better states for the Original Medicare plus Medigap track. The state guarantees disabled beneficiaries under 65 the right to buy certain Medigap plans, and the competitive Medigap market (23 carriers statewide) produces reasonable premiums. If you travel frequently between states, have a specialist outside New Jersey's urban corridor, or prefer no-authorization care, Original Medicare plus Medigap often wins on simplicity and network breadth.
If you spend most of your time in New Jersey, want lower monthly premiums, and value extras like dental, vision, and fitness benefits, Medicare Advantage is worth comparing. The 2026 Part B premium is $202.90 per month regardless of which track you choose, and you pay it in addition to any MA premium or Medigap premium.
Medicare Advantage vs Original Medicare in New Jersey detail| Feature | Medicare Advantage (MA) | Original Medicare + Medigap |
|---|
| Avg monthly premium (NJ) | $25/mo (MA only; add $202.90 Part B) | $200-$400/mo Medigap + Part D + $202.90 Part B |
| Annual out-of-pocket cap | $2,900-$9,250 (plan sets the limit) | Unlimited (Medigap covers most gaps) |
| Provider choice | In-network required (PPO adds out-of-network at higher cost) | Any Medicare-accepting provider nationwide |
| Prior authorization | Often required for imaging, surgery, specialists | Rarely required |
| Extras (dental, vision, hearing) | Included in most plans | Not included; buy separately |
This comparison is simplified. Actual costs depend on your specific plan, usage, and health status.
How Star Ratings work in New Jersey
CMS publishes Medicare Advantage Star Ratings every October, rating plans 1 to 5 stars based on roughly 40 quality measures: chronic disease management, customer service, member satisfaction, and Part D drug safety. Plans rated 4 stars or higher receive quality bonus payments from CMS, which plans often reinvest into richer benefits the following year.
For 2026, New Jersey's MA market sits slightly above the national average. UnitedHealthcare has multiple NJ plans rated 5 stars, which creates a Special Enrollment Period (December 8, 2026 through November 30, 2027) allowing you to switch into those plans outside AEP. Aetna NJ plans average 4.2 stars. Braven Health and Horizon NJ TotalCare average 4.0 stars. Clover Health and WellCare NJ plans average 3.5 stars. The national average for all MA plans in 2026 is 3.66 stars.
A higher Star Rating is a useful signal but is not the only thing to check. A 4.5-star plan with a network that excludes your doctor is worse for you than a 3.5-star plan that includes them. Check whether your doctors are in-network before enrolling. Use Star Ratings as a filter, then verify network and formulary.
How to enroll in Medicare Advantage in New Jersey
To enroll in a Medicare Advantage plan in New Jersey, you must first be enrolled in Medicare Part A and Part B. Check whether you qualify for Extra Help with Part D costs — it can significantly reduce your drug expenses. Most people enroll in Parts A and B during their 7-month Initial Enrollment Period around age 65. If you are still working and covered by an employer plan, you may delay Part B without penalty until you lose that coverage.
Once enrolled in Parts A and B, you can join a Medicare Advantage plan through four channels: online at medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), by contacting a plan directly, or through a licensed insurance broker or agent. New Jersey's State Health Insurance Assistance Program (SHIP), called SHIP NJ, provides free one-on-one counseling to help you compare plans. Call 1-800-792-8820 to reach SHIP NJ.
New Jersey has 21 counties, all of which have at least some MA plan options. Plan availability varies significantly: Bergen and Essex counties offer 32 or more plans, while Warren County offers around 12. Always search by your specific ZIP code at medicare.gov for the most accurate count.
Frequently Asked Questions
How many Medicare Advantage plans are available in New Jersey in 2026?
New Jersey has 85 Medicare Advantage plans available statewide in 2026, down from 92 in 2025. The exact count in your area depends on your county and ZIP code. Bergen County has about 36 plans; Warren County in the far northwest has around 12. Run a ZIP-code search at medicare.gov to see your exact options.
What is the average Medicare Advantage premium in New Jersey for 2026?
The statewide average monthly premium for Medicare Advantage in New Jersey is about $25 in 2026, above the national MA average of $14. However, every NJ Medicare beneficiary has access to at least one $0-premium plan. $0-premium PPO options from Clover Health, WellCare, and Humana are available statewide. Premiums can range from $0 to $180 or more depending on plan type and coverage richness.
Who offers the best Medicare Advantage plans in New Jersey?
For 2026, UnitedHealthcare has multiple 5-star plans in New Jersey, the highest CMS rating possible, which also triggers a year-round Special Enrollment Period. Aetna NJ plans average 4.2 stars and offer the widest plan count (13 plans) with both HMO and PPO options. Braven Health (Horizon BCBS NJ) averages 4.0 stars and is the best fit if your care is centered at Hackensack Meridian or RWJBarnabas hospitals. The best plan for you depends on your doctors, medications, and how much flexibility you need.
When can I sign up for Medicare Advantage in New Jersey?
The main window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period if you move, lose employer coverage, or qualify for NJ FamilyCare (dual eligible). Existing MA members can switch plans during the MA Open Enrollment Period (January 1 to March 31, 2026).
What is the difference between Braven Health and Horizon Blue Cross Blue Shield in NJ Medicare?
Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) is the state's largest insurer and uses Braven Health as its dedicated Medicare Advantage brand. Braven Health plans are jointly developed with Hackensack Meridian Health and RWJBarnabas Health and are built around those hospital networks. Horizon also sponsors Horizon NJ TotalCare, the D-SNP plan for dual-eligible (NJ FamilyCare + Medicare) beneficiaries. If you see 'Braven Health' or 'Horizon NJ TotalCare', both trace back to Horizon BCBSNJ.
Does New Jersey have a dual-eligible Medicare Advantage option?
Yes. New Jersey's Medicaid program is called NJ FamilyCare. If you qualify for both NJ FamilyCare and Medicare, you are dual eligible and can enroll in a Dual Special Needs Plan (D-SNP). Horizon NJ TotalCare (HMO D-SNP) is the primary option and typically carries $0 premiums and $0 copays. Dual eligibles can also change MA plans once per quarter during Q1, Q2, and Q3, in addition to during AEP.
Can I switch from Medicare Advantage back to Original Medicare in New Jersey?
Yes. You can switch during the Annual Election Period (October 15 to December 7) or during the MA Open Enrollment Period (January 1 to March 31). Returning to Original Medicare does not automatically give you access to Medigap, however. Medigap carriers are generally not required to sell you a policy outside your initial enrollment window unless you have a guaranteed issue right. NJ does provide guaranteed issue rights for disabled beneficiaries under 65, and certain other situations. Review your options with a SHIP NJ counselor (1-800-792-8820) before making this switch.
Does Medicare Advantage cover prescription drugs in New Jersey?
Most New Jersey Medicare Advantage plans include Part D prescription drug coverage. These are called MA-PD plans. The 2026 Part D annual out-of-pocket maximum is $2,100 across all MA-PD plans (set by the Inflation Reduction Act signed in August 2022). Insulin is capped at $35 per month under all Part D plans. Always check the specific plan's formulary to confirm your medications are covered at a tier you can afford.
