Medicare/Advantage (Part C)
Medicare Advantage · Part C
All-in-one Medicare — bundled, often at $0 premium.
Part A, Part B, drugs, dental, vision, and more — wrapped into a single private plan. Compare NJ carriers side by side.
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NJ carriers compared
What it looks like in the finder
Sample NJ Advantage Plan
HMO · Part C (includes Part D)
$0
/mo premium
- Part A hospital coverage included
- Part B outpatient coverage included
- Prescription drugs (Part D) included
- Dental: preventive + $1,500 comprehensive
- Vision: annual exam + $200 eyewear
- OTC allowance: $100/quarter
- SilverSneakers gym benefit
- Annual in-network out-of-pocket cap: $4,900
Illustrative only. Actual plans vary by county and carrier. TrueCost models your expected utilization.
What's bundled
Everything Original Medicare covers — plus more
By law, Advantage plans must cover all Part A and Part B benefits. Most go further.
- Part A — hospital, skilled nursing, hospice
- Part B — doctor visits, outpatient, preventive
- Part D — prescription drugs (most plans)
- Dental cleanings, exams, and X-rays
- Routine vision exams and eyewear allowance
- Hearing exams and hearing-aid benefit
- Over-the-counter (OTC) product allowance
- Fitness memberships (SilverSneakers and others)
- Transportation to medical appointments
Extra benefits
Coverage Original Medicare doesn't offer
These extras are the reason many NJ enrollees choose Advantage over Original Medicare.
Dental
Preventive and comprehensive dental
Most NJ Advantage plans cover preventive cleanings, X-rays, and exams at no cost. Richer plans add comprehensive coverage for fillings, extractions, and dentures up to an annual maximum.
- Two cleanings per year at $0 copay
- Annual X-rays and oral exams
- Comprehensive: fillings, crowns, dentures
- Typical annual maximum: $1,000–$2,500
Vision
Annual eye exams and eyewear credit
Original Medicare does not cover routine vision. Advantage plans routinely include an annual exam plus a benefit toward glasses or contacts.
- Annual comprehensive eye exam
- Eyewear (glasses or contacts) allowance: $100–$300/year
- Some plans include contact lens fitting
- Allowance loads onto a plan debit card
OTC + Home
OTC allowance and in-home support
A quarterly credit covers over-the-counter items like vitamins, pain relievers, and first-aid supplies. Some plans add a home-visit benefit for safety assessments.
- Quarterly OTC allowance: $50–$200
- Items ordered online or at partner pharmacies
- In-home health and safety assessments
- Transportation to medical appointments
Plan structure
HMO vs. PPO — which fits your life?
The network type affects your flexibility, your cost, and whether you need referrals.
| Feature | HMO★ popular | PPO |
|---|---|---|
| Monthly premium | Lowest | Higher |
| Use out-of-network providers | — | |
| PCP referral required | Usually yes | No |
| Out-of-pocket cap (in-network) | Up to $4,900 | Up to $7,550 |
| Best for | Predictable care near home | Flexibility, travel, specialists |
Caps are illustrative 2025 ranges. Actual limits vary by plan and carrier.
A $0 premium isn't the whole story
A plan with a $0 premium and $45 specialist copays can cost more annually than a $40/month plan with $10 specialist copays — if you see specialists regularly. Yumi's TrueCost tool models your expected utilization so you compare total yearly cost, not just the sticker price.
Run a TrueCost comparison →All extra benefits
What else comes with most NJ plans
Vision
Annual exam + eyewear allowance. Original Medicare covers neither.
Learn moreHearing
Hearing exams and a hearing-aid benefit — valued at $500–$2,000/year.
Learn moreOTC Allowance
Quarterly credit for over-the-counter health items, loaded onto a plan debit card.
Learn moreFitness
SilverSneakers and similar programs give gym access at thousands of locations nationwide.
Learn moreTransportation
Rides to and from covered medical appointments — up to a set number of trips per year.
Learn moreMeal Delivery
Some plans include post-hospitalization meal delivery. Ask your advisor which NJ plans include it.
Learn moreFAQ
Medicare Advantage questions
Is a $0 premium Medicare Advantage plan really no cost?+
The monthly plan premium can be $0, but you still pay your Part B premium ($185/mo standard in 2025) plus any copays or coinsurance when you use care. A $0-premium plan may have higher copays than a plan with a small monthly cost — compare total yearly cost, not just the premium.
Which NJ carriers offer Medicare Advantage?+
In New Jersey: Horizon BCBSNJ, Aetna, UnitedHealthcare/AARP, Humana, Cigna, Wellcare, Clover Health, and Devoted Health. Plan availability varies by county.
Can I keep my doctors on a Medicare Advantage plan?+
Only if they are in the plan's network. Always verify your primary care physician and any specialists are in-network before enrolling. Networks change annually.
What happens if I travel or need emergency care outside NJ?+
Medicare Advantage plans must cover emergency and urgent care nationwide. Routine care outside the service area is generally not covered on HMO plans; PPO plans offer out-of-network coverage at higher cost.
When can I switch Medicare Advantage plans?+
During AEP (Oct 15 – Dec 7), the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31), or a qualifying Special Enrollment Period. Outside these windows you are generally locked into your plan.
Which Medicare Advantage carriers serve all NJ counties in 2026?+
Statewide NJ Medicare Advantage carriers for 2026 include UnitedHealthcare, Aetna, Humana, Wellcare, Clover Health, and Cigna HealthSpring. Braven Health, Devoted Health, and AmeriHealth NJ cover most counties. Plan availability — and which doctors and hospitals are in-network — varies by ZIP code. We check your county and your specific doctors before recommending a plan.
Can I switch from Medicare Advantage back to Original Medicare in NJ?+
Yes. The Medicare Advantage Open Enrollment Period (January 1 – March 31) lets you switch Advantage plans or return to Original Medicare once per year. The Annual Enrollment Period (October 15 – December 7) gives you a broader window. Note: switching back to Original Medicare in NJ may not be guaranteed-issue for Medigap if you're past your initial enrollment, so check Medigap underwriting before you switch.
Will my NJ doctor accept Medicare Advantage?+
Most NJ doctors and hospitals participate in at least one Medicare Advantage network, but not every plan. Hackensack Meridian, RWJBarnabas, Atlantic Health, Holy Name, and Inspira are in-network with most major Advantage carriers — but verify before enrolling. A Yumi Health advisor will run your specific doctors against each plan's network for you at no cost.
Find your Advantage plan.
Compare NJ carriers side by side — a licensed advisor can narrow the field in minutes.