We researched the best Medicare Advantage plans in New Jersey to identify top providers by plan type, focusing on CMS star ratings, premium costs and maximum out-of-pocket (MOOP) limits to highlight the best value. Clover Health leads the state for HMO coverage and PPO plans, while Wellcare is the top choice for HMO-POS options.
Best Medicare Advantage Plans in New Jersey (2026)
Updated: January 23, 2026
Advertising & Editorial Disclosure
Key Takeaways
New Jersey residents have access to nine Medicare Advantage providers with 49 plans to choose from. Monthly premiums range from $0 to $182, while maximum out-of-pocket (MOOP) limits range from $2,900 to $9,250 annually.
Clover Health is the best Medicare Advantage provider in New Jersey for both HMO and PPO plans in New Jersey, while Wellcare leads for HMO-POS plans.
When choosing a Medicare Advantage plan in New Jersey, it’s important to consider the doctors and hospitals you want to access, your prescription drug requirements and your overall budget.
Best Medicare Advantage Providers in New Jersey
| HMO | Clover Health | 4.00 | $0 | $6,000 | Clover Health Classic (HMO) |
| HMO-POS | Wellcare | 3.50 | $45 | $9,250 | Wellcare Low Premium (HMO-POS) |
| PPO | Clover Health | 3.50 | $0 | $8,500 | Clover Health Choice Giveback (PPO) |
Medicare Advantage Plans Explained
Medicare Advantage plans give you extra benefits like dental, vision, and prescription drug coverage that Original Medicare doesn't include. Private insurance companies offer these plans while covering all your Part A and Part B services through one convenient package.
- CMS Star Ratings: These ratings help you spot quality plans by scoring them from 1 to 5 stars. Plans with 4 or 5 stars offer better customer service and care coordination.
- Monthly premiums: Many plans in the Garden State charge $0 beyond your standard Part B premium. Your total monthly cost depends on which plan you choose and where you live.
- Maximum out-of-pocket (MOOP) limits: This safety net protects you from huge medical bills each year. Once you hit your limit, your plan covers 100% of remaining costs for covered services.
- Prescription drug coverage: Most plans bundle Part D medication benefits right into your coverage. You'll get access to necessary prescriptions at lower costs than paying full price.
Clover Health
Best HMO
MoneyGeek Rating
5/ 5
5/5Affordability
5/5Quality
5/5Availability
CMS Star Rating
4.0Plan Types
HMO, PPO
WellCare
Best HMO-POS
MoneyGeek Rating
5/ 5
5/5Affordability
5/5Quality
5/5Availability
CMS Star Rating
3.5Plan Types
HMO-POS
Best New Jersey HMO Medicare Advantage Providers
New Jersey seniors have a range of HMO Medicare Advantage options that balance cost, coverage, and network access. Out-of-pocket limits for these plans range from $4,500 to $9,250, averaging $7,550 annually. Across 10 plans from five providers, seven charge $0 monthly premiums. The average CMS star rating is 3.7, with five plans earning 4 stars or higher. All include enhanced Part D drug coverage.
- Clover Health offers two plans with a 4.0-star rating, including one $0-premium option and an average $6,000 MOOP.
- Humana provides two plans averaging $0 monthly, earning 3.5 stars, though maximum out-of-pocket costs are higher at $8,643.
- Aetna delivers three 4.0-star plans, charging $44 per month with $9,250 average MOOP limits.
| Clover Health | 4.00 | $0 | $6,000 | 2 | 5.00 |
| Humana | 3.50 | $0 | $8,643 | 2 | 4.27 |
| Aetna | 4.00 | $44 | $9,250 | 3 | 3.98 |
| Cigna HealthCare | 3.00 | $0 | $7,500 | 1 | 3.98 |
| Jefferson Health Plans | 3.50 | $0 | $6,250 | 2 | 3.75 |
HMO PROS AND CONS
HMO Medicare Advantage plans require you to stay within a provider network and get referrals for specialist care. You'll benefit from lower premiums, reduced out-of-pocket costs, and coordinated care that makes managing your health care easier. These plans work well if you're comfortable having a primary care doctor coordinate your treatment and don't need out-of-network specialists.
Best New Jersey HMO-POS Medicare Advantage Providers
HMO-POS plans in New Jersey offer valuable out-of-network access, though often at higher costs than standard HMOs. The state has 13 plans from three providers, averaging $46 per month, with five plans charging $0 premiums for budget-conscious seniors. Maximum out-of-pocket (MOOP) limits range from $2,900 to $9,250, averaging $7,434. This is higher than traditional HMOs but provides protection for members who occasionally need out-of-network care.
- Wellcare offers four plans, including two $0-premium options, averaging $45 monthly with $9,250 MOOP and a 3.5-star rating.
- UnitedHealthcare provides the most choices with seven plans averaging $46 per month, 3.68 stars, and a $6,440 average MOOP.
- Aetna leads in quality with two plans rated 4.0 stars at $37 per month with a $9,250 average MOOP.
| Wellcare | 3.50 | $45 | $9,250 | 4 | 5.00 |
| UnitedHealthcare | 3.68 | $46 | $6,440 | 7 | 4.10 |
| Aetna | 4.00 | $37 | $9,250 | 2 | 3.99 |
HMO-POS PROS AND CONS
HMO-POS plans suit people who want coordinated, affordable care but need occasional flexibility to visit out-of-network providers. These hybrid plans let you keep most cost benefits of standard HMOs while accessing out-of-network doctors when necessary, though you'll pay more for that flexibility. They're ideal if you prefer predictable premiums and don't mind using a primary care physician for most coordination.
Best New Jersey PPO Medicare Advantage Providers
PPO plans in New Jersey offer greater network flexibility but generally come with higher costs than more restrictive alternatives. The state has 25 PPO plans from seven providers, averaging $29 per month, though 13 plans charge $0. Maximum out-of-pocket (MOOP) limits range from $6,800 to $9,250, averaging $8,707, reflecting the additional cost of out-of-network access. These plans average 3.78 stars, with nine earning 3.5 stars. All include enhanced Part D prescription coverage and waive deductibles on select medication tiers.
- Clover Health leads the PPO market with four $0-premium plans, $8,500 MOOP, and 3.5-star ratings.
- Cigna HealthCare offers one plan at $0 premium with the state’s lowest $6,800 MOOP, though it carries a 3.0-star rating.
- Humana ranks third with three plans averaging $10 per month, $7,893 MOOP, and the highest 3.84-star rating among top providers.
| Clover Health | 3.50 | $0 | $8,500 | 4 | 5.00 |
| Cigna HealthCare | 3.00 | $0 | $6,800 | 1 | 4.42 |
| Humana | 3.84 | $10 | $7,893 | 3 | 4.41 |
| Aetna | 4.50 | $61 | $9,250 | 8 | 3.98 |
| UnitedHealthcare | 3.50 | $39 | $8,117 | 3 | 3.95 |
| Braven Health | 4.00 | $25 | $9,188 | 3 | 3.85 |
| AmeriHealth | 2.50 | $0 | $9,250 | 3 | 3.75 |
PPO PROS AND CONS
You'll pay more with PPO Medicare Advantage plans through higher monthly premiums and out-of-pocket maximums, but you get complete provider flexibility. These plans let you visit any Medicare-approved doctor without referrals and give you access to both in-network and out-of-network care, though staying in-network saves money.
How to Find the Best New Jersey Medicare Advantage Plans
Finding the right Medicare Advantage plan in New Jersey requires evaluating your healthcare needs and total costs, not just monthly premiums.
- 1Check Your Doctor and Hospital Network
Before choosing a Medicare Advantage plan, confirm your current doctors, specialists and preferred hospitals participate in the plan's network. HMO plans restrict you to in-network providers except for emergencies, while PPO plans allow out-of-network access at higher costs. Learn more about health insurance network types to understand these differences.
- 2Compare Maximum Out-of-Pocket Costs
Don't focus only on monthly premiums when evaluating plans in New Jersey. Consider the maximum out-of-pocket costs, which cap your annual spending for covered services. A plan with a $0 premium but $7,833 maximum out-of-pocket could cost more than one with a $29 premium and $6,750 cap if you need frequent medical care.
- 3Review Prescription Drug Coverage
Check that your medications appear on the plan's drug formulary and understand their tier placement, which affects your costs. Most Medicare Advantage plans include Part D prescription drug coverage, though some require separate enrollment. Higher-tier drugs cost more out-of-pocket than lower-tier medications.
- 4Evaluate Additional Benefits
Medicare Advantage plans often include extras beyond basic coverage, such as dental care, vision services, hearing aids, fitness memberships and transportation to medical appointments. These supplemental benefits can provide value and enhance your healthcare experience. Compare which additional services each plan offers and whether they match your specific needs.
- 5Consider CMS Star Ratings
Review each plan's CMS star rating, which measures quality and performance on a scale from 1 to 5 stars. Higher-rated plans deliver better customer service, care coordination and health outcomes. Plans earning 4 or 5 stars generally provide superior member experiences compared to lower-rated options.
Average New Jersey Medicare Advantage Cost
Network design drives Medicare Advantage costs in New Jersey. Plans with narrower networks generally keep premiums and out-of-pocket expenses lower, while broader access increases costs.
HMO plans offer the state’s most affordable coverage, with $0 median premiums and $7,550 average maximum out-of-pocket (MOOP). PPO plans also have $0 median premiums but higher MOOPs at $8,708 to account for out-of-network access. HMO-POS plans average $34 per month with $7,435 MOOP, providing added point-of-service flexibility. Regional PPOs carry the highest costs, with $139 monthly premiums and $9,250 MOOP, reflecting their nationwide network coverage.
| HMO | $0 | $15 | $7,550 |
| HMO-POS | $34 | $46 | $7,435 |
| PPO | $0 | $29 | $8,708 |
| Regional PPO | $139 | $139 | $9,250 |
Best New Jersey Medicare Advantage: FAQ
Get answers about New Jersey Medicare Advantage plans:
When can I enroll in a Medicare Advantage plan in New Jersey?
In New Jersey, enrollment occurs during the Annual Enrollment Period (Oct. 15 - Dec. 7) and the Medicare Advantage Open Enrollment Period (January 1 - March 31). You may also enroll during a Special Enrollment Period if you qualify due to circumstances like relocating or losing other coverage.
Does Medicare Advantage cover prescription drugs in New Jersey?
Most Medicare Advantage plans in New Jersey include prescription drug coverage built into the plan. Before enrolling, confirm your medications appear on the plan's formulary and review their tier placement, which directly impacts your out-of-pocket costs at the pharmacy.
Do I need to change Medicare Advantage plans if I move to a different county in New Jersey?
You may need to switch plans since Medicare Advantage networks vary by county location. Contact your plan provider within 30 days of relocating to verify continued coverage availability. You can utilize a Special Enrollment Period to enroll in a different plan if necessary.
Our Methodology: How We Chose the Best New Jersey Medicare Advantage Plans
We assessed Medicare Advantage plans in New Jersey using an evaluation framework that emphasizes cost and quality. Three core criteria identify plans with the strongest value:
- Affordability (50%): Costs represent half the total score due to their immediate effect on your spending. We analyzed combined monthly premiums for Part C and Part D coverage (weighted at 30%) and in-network maximum out-of-pocket limits (weighted at 20%). Plans with lower premiums and MOOP thresholds score higher by reducing annual health care expenses.
- Star Ratings (40%): CMS star ratings assess plan performance in care quality, customer service and member experience. The Overall Star Rating merges Part C (medical benefits) and Part D (prescription drug coverage) scores into one rating on a 1 to 5-star scale. Higher-rated plans score better in our evaluation.
- Availability (10%): We consider each insurer's coverage area across the United States. Providers serving more states score higher, as broader availability indicates more robust infrastructure, better support and better continuity if you relocate.
These factors create a fair comparison of Medicare Advantage plans, weighing costs against care quality and service.
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.
Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!
He writes about economics and insurance, breaking down complex topics so people know what they're buying.