Aetna Medicare
Avg Star Rating
4.2 ★
Plan
Premium
MOOP
Stars
Type
Compare & Enroll — Part C & Part D
Compare & Enroll in Medicare Plans in Sussex County, NJ
With 36 Medicare Advantage options from 9 insurers, Sussex County, NJ has fewer plan options than the national average, suggesting a highly competitive market where insurers often lower premiums to attract members. Approximately 86% of local MA plans charge $0 beyond the standard Part B premium, reflecting strong price competition. The 9 hospitals within 25.0 miles provide reasonable inpatient access for most plan networks. We've organized the CMS data below to help you cross-reference plan costs, quality ratings, and local provider access. Compare plans below, and when you're ready, enroll directly at Medicare.gov.
📊 Direct from CMS
🚫 No agents or commissions
✓ Just the data, no sales pitch
Compare Plans at Medicare.gov →
Data freshness: CMS data as of February 2026 •
ACS data as of 2023 •
Reviewed & approved on 2026-02-16
Reviewed by: Wes Ward, Founder & Data Lead •
View our methodology
Important: We are not affiliated with Medicare or any government agency. This site displays publicly available CMS data to help you compare plans. We do not sell insurance or represent any insurance company. For official enrollment and complete plan information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Important: Plan availability, benefits, and CMS Star Ratings shown here come directly from CMS public files. Plan details can change—always verify with the insurer and at Medicare.gov.
Part C Plans
36
Part D Plans
12
Top MA Star
4.5
Top Drug Star
3.5
Medicare Eligibility in Sussex County, NJ
Approximately 27,249 residents (18.1% of the population) in Sussex County, NJ are 65 or older and likely Medicare-eligible. Whether you're approaching 65, already enrolled, or a caregiver comparing options, the plan data below is organized to help you evaluate Part C (Medicare Advantage) and Part D (prescription drug) coverage side by side.
The median household income in Sussex County, NJ is $122,817 (63.4% above the National Average), which may affect eligibility for Extra Help with Part D drug costs.
Part C: Medicare Advantage Plans
Medicare Advantage (Part C) replaces Original Medicare through private insurers who bundle hospital, medical, and often drug coverage into a single plan. Sussex County, NJ's 36 Medicare Advantage plans are a mix leaning toward HMO networks (20 HMO, 16 PPO). 31 plans offer $0 monthly premiums. The average local star rating is 3.6 out of 5, with the top plan earning 4.5 ★.
Top Medicare Advantage Plans in Sussex County, NJ
We organize CMS plan data into separate leaderboards so you can compare based on what matters most to you. Part C premiums in Sussex County, NJ range from $0 to $34/month. Among rated plans, 12 plans rated 4+ stars.
Highest CMS Star Ratings
Star Ratings are assigned by CMS based on quality measures including customer service, preventive care, and managing chronic conditions.
| Plan Name | Insurer | Star Rating | Premium | Type | |
|---|---|---|---|---|---|
| Aetna Medicare Prime (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
| Aetna Medicare Prime Giveback (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
| Aetna Medicare Prime Extra (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
| Aetna Medicare Enhanced Extra (PPO) | Aetna Medicare | 4.5 ★ | $9.40/mo | PPO | Enroll |
| Aetna Medicare Eagle Giveback (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
Lowest Monthly Premium
Lower premiums can save money, but check total costs including deductibles, copays, and MOOP.
| Plan Name | Insurer | Monthly Premium | MOOP | Star Rating |
|---|---|---|---|---|
| Aetna Medicare Prime (HMO-POS) | Aetna Medicare | $0.00/mo | $9,250 | 4.0 ★ |
| Aarp Medicare Advantage From Uhc Nj-0004 (PPO) | Unitedhealthcare | $0.00/mo | $7,900 | 3.5 ★ |
| Aarp Medicare Advantage From Uhc Nj-0005 (PPO) | Unitedhealthcare | $0.00/mo | $7,550 | 3.5 ★ |
| Aetna Medicare Prime (PPO) | Aetna Medicare | $0.00/mo | $9,250 | 4.5 ★ |
| Aetna Medicare Prime Giveback (PPO) | Aetna Medicare | $0.00/mo | $9,250 | 4.5 ★ |
Lowest Maximum Out-of-Pocket (MOOP)
MOOP caps your financial risk. Once you hit this limit, the plan covers 100% of covered services for the rest of the year.
| Plan Name | Insurer | MOOP (In-Network) | Premium | Star Rating |
|---|---|---|---|---|
| Aarp Medicare Advantage From Uhc Nj-0003 (HMO-POS) | Unitedhealthcare | $6,500 | $0.00/mo | 3.5 ★ |
| Aarp Medicare Advantage Essentials From Uhc Nj-1 (HMO-POS) | Unitedhealthcare | $6,700 | $0.00/mo | 3.5 ★ |
| Aarp Medicare Advantage Extras From Uhc Nj-7 (HMO-POS) | Unitedhealthcare | $6,700 | $0.00/mo | 3.5 ★ |
| Aarp Medicare Advantage From Uhc Nj-0002 (HMO-POS) | Unitedhealthcare | $6,700 | $0.00/mo | 3.5 ★ |
| Aarp Medicare Advantage Patriot No Rx Nj-Ma2 (PPO) | Unitedhealthcare | $6,700 | $0.00/mo | 3.5 ★ |
Plan Type Mix in Sussex County, NJ
HMO plans require referrals and in-network care. PPO plans offer more flexibility. SNP (Special Needs Plans) serve specific populations. MAPD plans include drug coverage.
| Plan Type | Count | Percentage | Description |
|---|---|---|---|
| PPO | 15 | 41.7% | No referrals; in and out-of-network |
| HMO-POS | 11 | 30.6% | HMO with some out-of-network options |
| HMO D-SNP | 5 | 13.9% | Medicare Advantage plan |
| HMO | 3 | 8.3% | Requires referrals; in-network only |
| Regional PPO | 1 | 2.8% | Medicare Advantage plan |
| HMO-POS D-SNP | 1 | 2.8% | Medicare Advantage plan |
Choosing the Right Medicare Advantage Plan
The best Part C plan depends on your doctors, medications, and budget. Key factors to evaluate:
- Provider network: Verify your doctors and hospitals near Sussex County, NJ are in-network before enrolling
- Total cost: A $0 premium may have higher copays—calculate your annual cost
- Star Ratings: 4+ stars indicate above-average quality and member satisfaction
Read our full guide on choosing Medicare Advantage → · Print our enrollment checklist →
Medicare Glossary: HMO, PPO, MOOP & more →
Medicare Advantage Insurers in Sussex County, NJ
9 insurance companies offer Medicare Advantage plans in Sussex County, NJ. Below, we group plans by insurer so you can compare options from each company. More insurers generally means more competition and better benefits for consumers.
Unitedhealthcare
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Clover Health
Avg Star Rating
3.5 ★
Braven Health
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Horizon Blue Cross Blue Shield Of New Jersey
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Wellcare
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Wellpoint
Avg Star Rating
3.0 ★
Aetna Better Health Of New Jersey
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Healthspring
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Part D: Prescription Drug Plans (PDP)
Part D covers prescription drugs through standalone plans for those on Original Medicare, or as part of a Medicare Advantage bundle. Among the 12 standalone Part D plans in Sussex County, NJ, some offer $0 annual deductibles while others charge up to the 2026 maximum of $590. 2 plans are at or below the regional premium benchmark, making them eligible for Low Income Subsidy auto-enrollment. The 2026 $2,000 out-of-pocket cap means drug costs are now more predictable regardless of which plan you choose, but formulary coverage still varies significantly—always verify your medications are covered before enrolling.
Part D Formulary Notice: Each Part D plan has its own formulary (list of covered drugs). The same medication may be on different tiers—or not covered at all—depending on the plan. Always check that your specific medications are covered before enrolling.
2026 Out-of-Pocket Cap: Thanks to the Inflation Reduction Act, your total out-of-pocket drug costs are capped at $2,000 per year in 2026. Once you reach this limit, you pay nothing more for covered Part D drugs for the rest of the year. This eliminates the old "donut hole" coverage gap that previously caused higher costs.
Low Income Subsidy (LIS / Extra Help): If you have limited income and resources, you may qualify for Extra Help paying Part D costs. Visit SSA.gov or call 1-800-MEDICARE.
Top Part D Drug Plans in Sussex County, NJ
We organize Part D plans by CMS Star Ratings, premiums, and deductibles so you can find the best fit for your prescription needs. Part D premiums in Sussex County, NJ range from $4 to $139/month. Remember: all Part D plans now cap your annual out-of-pocket drug costs at $2,000 thanks to the Inflation Reduction Act.
Highest CMS Star Ratings (Part D)
Part D Star Ratings measure drug pricing, customer service, member complaints, and pharmacy access.
| Plan Name | Insurer | Star Rating | Premium | Deductible | |
|---|---|---|---|---|---|
| Wellcare Value Script (PDP) | Wellcare | 3.5 ★ | $22.80/mo | $615 | Enroll |
| Wellcare Classic (PDP) | Wellcare | 3.5 ★ | $28.20/mo | $615 | Enroll |
| Horizon Medicare Blue Rx Enhanced (PDP) | Horizon Blue Cross Blue Shield Of New Jersey | 3.5 ★ | $139.10/mo | $200 | Enroll |
| Horizon Medicare Blue Rx Standard (PDP) | Horizon Blue Cross Blue Shield Of New Jersey | 3.5 ★ | $72.30/mo | $615 | Enroll |
| Humana Basic Rx Plan (PDP) | Humana | 3.0 ★ | $4.40/mo | $615 | Enroll |
Lowest Monthly Premium
Lower premiums help with monthly cash flow, but check drug tier costs and the deductible.
| Plan Name | Insurer | Monthly Premium | Drug Deductible | Star Rating |
|---|---|---|---|---|
| Humana Basic Rx Plan (PDP) | Humana | $4.40/mo | $615 | 3.0 ★ |
| Wellcare Value Script (PDP) | Wellcare | $22.80/mo | $615 | 3.5 ★ |
| Wellcare Classic (PDP) | Wellcare | $28.20/mo | $615 | 3.5 ★ |
| Humana Value Rx Plan (PDP) | Humana | $35.60/mo | $601 | 3.0 ★ |
| Healthspring Extra Rx (PDP) | Healthspring | $59.90/mo | $615 | 2.5 ★ |
Lowest Annual Drug Deductible
The deductible is what you pay out-of-pocket before the plan starts covering drug costs. The 2026 maximum Part D deductible is $590. Many plans offer $0 deductible options.
| Plan Name | Insurer | Drug Deductible | Monthly Premium | Star Rating |
|---|---|---|---|---|
| Humana Premier Rx Plan (PDP) | Humana | $0 | $111.90/mo | 3.0 ★ |
| Aarp Medicare Rx Preferred From Uhc (PDP) | Unitedhealthcare | $130 | $118.90/mo | 2.0 ★ |
| Horizon Medicare Blue Rx Enhanced (PDP) | Horizon Blue Cross Blue Shield Of New Jersey | $200 | $139.10/mo | 3.5 ★ |
| Humana Value Rx Plan (PDP) | Humana | $601 | $35.60/mo | 3.0 ★ |
| Humana Basic Rx Plan (PDP) | Humana | $615 | $4.40/mo | 3.0 ★ |
Understanding drug tiers: Part D plans organize medications into 5 cost tiers — Tier 1 (Preferred Generic) is cheapest; Tier 5 (Specialty) is most expensive. Two plans with the same premium can have very different costs for your drugs depending on tier placement. Learn more about drug tiers →
Choosing the Right Part D Drug Plan
The right Part D plan depends on your specific medications. Key factors to evaluate:
- Formulary: Verify your drugs are covered before enrolling
- Preferred pharmacies: Lower copays at certain locations—check your pharmacy is in-network
- Total annual cost: Premium + deductible + copays for your drugs
Read our full guide on choosing Part D →
What is a formulary? See our Medicare Glossary →
Part D Drug Plan Insurers in Sussex County, NJ
6 insurance companies offer standalone Part D drug plans in Sussex County, NJ. Below, we group plans by insurer.
Wellcare
Avg Star Rating
3.5 ★
Horizon Blue Cross Blue Shield Of New Jersey
Avg Star Rating
3.5 ★
Humana
Avg Star Rating
3.0 ★
Aetna Medicare
Avg Star Rating
3.0 ★
Plan
Premium
Deductible
Stars
Type
Healthspring
Avg Star Rating
2.5 ★
Unitedhealthcare
Avg Star Rating
2.0 ★
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Ready to Enroll in Sussex County, NJ?
Compare plans side-by-side at Medicare.gov or speak with a licensed Medicare specialist.
📋 Print our Medicare Enrollment Checklist — gather your info before you compare.
📅 Enrollment Dates & Deadlines · 🩺 Questions to Ask Your Doctor
Medicare.gov is the official U.S. government site for Medicare. Available 24/7.
Pharmacy Access in Sussex County, NJ
Part D plans have preferred pharmacy networks where you'll pay lower copays. Here's a look at pharmacy options in and around Sussex County, NJ.
Total Pharmacies
10
within 5.0 miles
Chain Pharmacies
6
CVS, Walgreens, etc.
Independent Pharmacies
4
locally owned
| Pharmacy | Address & Phone | Distance | Type |
|---|---|---|---|
| RONETCO SUPERMARKETS, INC | 18 NORTH VILLAGE BOULEVARD SPARTA, NJ 07871 973-392-8300 | 1.0 mi | Independent |
| SPARTA PHARMACY | 61 SPARTA AVE UNIT B SPARTA, NJ 078711822 973-351-3131 | 2.9 mi | Independent |
| THE STOP & SHOP SUPERMARKET COMPANY LLC | 5 TOWN CENTER DRIVE SPARTA, NJ 078711821 973-372-9161 | 3.5 mi | Chain |
| WALGREEN CO | 359 STATE RT 23 SUSSEX, NJ 074613141 973-387-0148 | 3.6 mi | Chain |
| NORTH COUNTRY DRUG INC. | 190 MUNSONHURST RD FRANKLIN, NJ 074161814 973-382-7340 | 3.7 mi | Independent |
| VIPAL INC. | 4 MAIN ST SPARTA, NJ 078711900 973-372-6101 | 3.9 mi | Independent |
| NEW JERSEY CVS PHARMACY LLC | 11 THEATRE CTR SPARTA, NJ 078712405 973-372-3422 | 4.2 mi | Chain |
| WAL-MART STORES EAST LP | 230 STATE RT 23 FRANKLIN, NJ 074162008 973-320-4253 | 4.5 mi | Chain |
| WAL-MART STORES EAST LP | 26 HAMPTON HOUSE RD NEWTON, NJ 078601409 973-330-4760 | 4.6 mi | Chain |
| WALGREEN CO | 17 HAMPTON HOUSE RD NEWTON, NJ 078603404 973-338-6000 | 4.9 mi | Chain |
Pharmacy data from CMS. Network participation varies by plan—always verify with your specific Part D plan.
Local Healthcare Access in Sussex County, NJ
Before choosing a plan, consider the healthcare infrastructure in Sussex County, NJ. Medicare Advantage plans restrict you to in-network hospitals, so understanding local hospital quality helps you pick the right plan — not just the cheapest one.
Note: The facilities below do not indicate which providers are in-network for any specific plan. Always verify network status with your plan before enrolling.
Hospitals Nearby
9
within 25.0 miles
Top-Rated Hospitals near Sussex County, NJ
If hospital access matters to your plan choice, check quality ratings before you enroll. These are the highest CMS-rated hospitals near Sussex County, NJ — click a hospital name to see its full profile and verify it's in your plan's network.
| Hospital | CMS Rating | Distance | Beds |
|---|---|---|---|
| St Anthony Community Hospital | 5 ★ | 19.2 mi | 60 |
| Morristown Medical Center | 5 ★ | 23.0 mi | 735 |
| Newton Medical Center | 4 ★ | 5.5 mi | 148 |
| Chilton Medical Center | 4 ★ | 20.2 mi | 260 |
| Saint Clare's Hospital/ Denville Campus | 3 ★ | 16.7 mi | 418 |
| Ahs Hospital Corp | 3 ★ | 17.9 mi | 148 |
| Bon Secours Community Hospital | 2 ★ | 19.2 mi | 141 |
| Kirby Forensic Psychiatric Center | Not Rated | 17.4 mi | 207 |
| Greystone Park Psychiatric Hospital | Not Rated | 19.0 mi | 468 |
| Mid Hudson Forensic Psychiatric Ctr | Not Rated | 25.6 mi | 280 |
View all 9 hospitals near Sussex County, NJ to check quality before you enroll →
Hospital data from CMS Hospital Compare and Provider of Services file. Distance calculated from center of Sussex County, NJ.
Telehealth in Sussex County, NJ: Is Your Internet Ready?
Many Medicare Advantage and some Part D plans now include telehealth benefits, making routine check-ins and prescription refills easier from home. But telehealth requires reliable internet—here's a look at connectivity in Sussex County, NJ. For official guidance on virtual visits, see Telehealth.HHS.gov from the U.S. Department of Health & Human Services.
Check Internet Providers at Your Address
Telehealth works best with reliable internet. Use this tool (provided free by ISP Reports) to see what's available at your address.
Opens ISP Reports in a new tab. This is not a paid relationship. Special thank you to ISP Reports for allowing free use of their address tool.
Internet Coverage in Sussex County, NJ
Fiber Available
90.9%
of households
Cable/DSL Available
99.8%
of households
Top Provider
Planet Networks
76.9% coverage
No Broadband
1.6%
of households
Internet coverage data from ISP Reports. View full internet report for Sussex County, NJ.
Medicare-Relevant Demographics in Sussex County, NJ
Understanding Sussex County, NJ's demographics helps contextualize why insurers offer the plans they do. Areas with more seniors and higher incomes tend to attract more insurer competition, while areas with higher Medicaid enrollment may have more Dual-Eligible Special Needs Plans (D-SNP) available.
Total Population
150,161
Population 65+
27,249
18.1% of total
Median Age
45
6.9 years older than the national average
Median Income
$122,817
63.4% above the National Average
On Medicare
24,060
16.0% of residents
On Medicaid
12,794
8.5% of residents
Uninsured
5,304
3.5% of residents
Social Security Recipients
48,928
32.6% of population
Demographic data from U.S. Census Bureau American Community Survey (2023). View full Sussex County, NJ demographics (BestNeighborhood.org).
Local Medicare FAQ: Sussex County, NJ
Common decision points based on Sussex County, NJ's specific plan market and local healthcare landscape.
How does Sussex County, NJ's Medicare Advantage market compare?
Sussex County, NJ has 36 Medicare Advantage plans from 9 insurers. This is below the national average of approximately 57 plans. In areas with fewer competing plans, it's especially important to compare the available options carefully. The local mix includes 20 HMO and 16 PPO plans. Plan availability updates annually during the Medicare Annual Enrollment Period (October 15 – December 7).
Should I choose an HMO or PPO Medicare Advantage plan in Sussex County, NJ?
With 9 hospitals within 25.0 miles, Sussex County, NJ has strong provider density. HMO plans (20 available) typically have lower premiums but require referrals and in-network care. PPO plans (16 available) offer more flexibility to see out-of-network providers at higher cost. In Sussex County, NJ, HMO plans dominate the market, which often means more competitive HMO pricing. Always verify your doctors are in-network before enrolling in any plan.
What's the real cost of $0 premium plans in Sussex County, NJ?
31 plans (86% of available options) in Sussex County, NJ charge $0 beyond the standard Part B premium. This high percentage reflects strong insurer competition in the area. However, $0 premium doesn't mean $0 cost. These plans may have higher copays, coinsurance, or out-of-pocket maximums. In Sussex County, NJ, maximum out-of-pocket limits range from $6,500 to an average of $8,589. We recommend calculating your total expected annual cost (premium + copays + drug costs) rather than choosing based on premium alone.
How does the 2026 $2,000 drug cap affect Sussex County, NJ beneficiaries?
The Inflation Reduction Act capped annual out-of-pocket drug spending at $2,000 starting in 2025, eliminating the old "donut hole" coverage gap. This applies to all 12 standalone Part D plans in Sussex County, NJ.
What this means locally:
- Cost predictability — No matter which of the 12 Part D plans you choose, your drug costs are capped at $2,000/year
- $0 deductible options — Some local plans offer $0 deductibles, meaning coverage starts immediately
- Low-income options — 2 plans meet the regional benchmark for Extra Help/LIS eligibility
While the out-of-pocket cap standardizes maximum costs, formulary coverage still varies significantly between plans. A drug that costs $5/month on one plan's formulary might cost $50 on another. Always check that your specific medications are covered and compare tier placement before enrolling.
See all Medicare FAQs in our complete guide → · Enrollment checklist →
Medicare Glossary · Enrollment Dates & Deadlines · Doctor Questions
About the Data & Editorial Team
Wes Ward
Founder & Data Lead
Wes Ward is the founder of InsuranceDataNow.org and reviews all content for data accuracy and methodology compliance.
With 25+ years in data analytics — including work with highly regulated genomic data at Ancestry.com — Wes brings enterprise-level rigor to consumer data tools. He is also a co-founder of BestNeighborhood.org, CrimeGrade.org, and ISPReports.org.
Role: Reviews and approves all content for data accuracy, source verification, and methodology compliance.
Transparency & Disclosures
InsuranceDataNow is an advertising-supported publisher based in South Jordan, Utah. We are not affiliated with or endorsed by Medicare or the U.S. government.
TPMO Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (24 hours a day/7 days a week) to get information on all of your options.
Sources
- CMS Medicare Plan Finder Data (Part C & D): cms.gov
- CMS Provider Directory: Hospital and pharmacy data from data.cms.gov
- American Community Survey: Demographic data from census.gov
- FCC Broadband Map: Internet availability data from broadbandmap.fcc.gov
- ISP Reports: Internet provider coverage for Sussex County, NJ from ispreports.org
- Telehealth.HHS.gov: Official telehealth guidance from U.S. Dept. of Health & Human Services
- BestNeighborhood.org: Community demographic profiles for Sussex County, NJ from bestneighborhood.org
All data is sourced from official government databases and trusted third-party providers. Data is updated regularly—see page header for last refresh dates.