Have Medicare in New Jersey? Medicare Advantage PPO Plans Could Be the Best Fit
If you're on a Medicare Advantage HMO Plan in New Jersey, you might want to think about switching to a PPO this year.
Over the past five years, more and more people in New Jersey have been choosing PPO plans over HMO plans because they could offer some better benefits for you while providing more provider access*. Here's a look at what's been happening and why you might want to consider a PPO plan for 2025.
PPO Plans Are Getting More Popular
In New Jersey, more than a third of people with Medicare are enrolled in a Medicare Advantage plan. These plans give you the same health benefits as Medicare, and they often include things like drug coverage and extra benefits for things like dental and vision care and over-the-counter allowances.
There are different Medicare Advantage options to pick from. One important choice is deciding between an HMO and a PPO plan. Some years ago, HMOs were much more popular in the state, but now, PPO plans are becoming more popular. Some years ago, for the individual Medicare Advantage market, HMOs were much more popular in the state, but now, PPO plans are becoming more popular. In New Jersey, the number of individuals on these PPO plans has more than doubled while the enrollment in these HMO plans has gone down.
Next, we'll look at New Jersey's 2025 HMO offering and why 2025 could be the year to think about switching to a PPO.
A Look at New Jersey HMO Medicare Choices
HMOs are known for their more restrictive network compared to PPOs. Typically, in an HMO, you need to have an assigned primary care physician (PCP), and referral from the PCP is required to seek additional care. Looking at the New Jersey HMO landscape for 2025, the juice may not be worth the squeeze.
Reviewing the 2025 benefits across the most popular HMO plans in the state (with over 2,000 members each), we asked questions like:
- How much is an in-network specialist copay?
- How competitive are the Part D costs?
- Does the plan offer a quarterly OTC allowance that can be spent on a variety of health and wellness items?
- Does the plan cover comprehensive dental? Is there an additional cost?
Looking across Clover’s New Jersey PPO plans we found:
- Clover PPO plans have low in-network specialist copays, including the lowest in the state at $2 for certain plans
- Clover has competitive Part D benefits with a low deductible, $0 Tier 1 copay, and as low as $5 - $8 Tier 2 copay, depending on the plan
- All Clover plans offer an OTC allowance, with the lowest amount at $50/quarter and the highest at $170/quarter
- Nearly all of our plans offer $1,250 or more in comprehensive dental allowance at no additional cost
There are many factors to consider when choosing a Medicare plan, but if you're in New Jersey and have a Medicare HMO plan, you might want to think about switching to a PPO plan during the Annual Enrollment Period from October 15 to December 7. If you want to learn more about PPO plans in New Jersey, you can find more information here. And if you want to learn about the differences between PPO and HMO plans, you can check that out here.
Clover Health is a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO) with a Medicare contract. Enrollment in Clover Health depends on contract renewal. Enrollment in a plan may be limited to certain times of the year unless you qualify for a special [election/enrollment] period or you are in your Medicare Initial Election Period.
*Out-of-network/non-contracted providers are under no obligation to treat Clover members, except in emergency situations.
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