New Jersey Hospital and Critical Illness Gap Calculator
Health insurance pays the hospital. It does not pay your mortgage while you recover. Enter the bills your plan leaves you, the income you could lose and the extra costs of getting better, then add a hospital indemnity daily benefit or a critical illness lump sum to see the gap.
Estimates only. Figures on this page use published values and the details you enter. They are not a quote, an offer of coverage, or a determination of eligibility. Coverage, benefit amounts and premiums are set by the carrier and subject to underwriting and approval. Everything is calculated in your browser; nothing you type is sent to us or anyone else.
How the cash gap of a serious illness is added up
The calculator separates what an illness costs your household from what your health plan pays, then sets cash benefits and savings against the total.
Cash policies are not health insurance. They pay you a fixed amount when a covered event happens, whatever the hospital charged, so the right size depends on your household budget rather than on medical prices.
- Medical bills: deductibles, copays and coinsurance your plan leaves you, up to its out-of-pocket limit.
- Lost income: monthly income lost × months of recovery.
- Extra costs: monthly travel, help at home or childcare × the same months.
- Benefits: a hospital indemnity daily benefit × days in hospital, plus any critical illness lump sum.
- Gap: total costs minus benefits minus savings you would use; a surplus shows if benefits and savings exceed costs.
Total cost = medical bills + (lost income + extra costs) × monthsBenefits = daily benefit × hospital days + lump sumGap = total cost minus benefits minus savings Worked example: a heart attack at 58 in a Mount Laurel household
Hypothetical household, not clients. He is 58 and has a heart attack. The inputs are illustrative: his plan leaves $7,000 in bills, he loses $4,000 a month of income for three months, and travel and help at home add $600 a month.
Costs: $7,000 + $12,000 + $1,800 = $20,800.
Benefits: five days in hospital at $250 a day pays $1,250, and a $15,000 critical illness benefit pays on diagnosis, $16,250 in all. With $3,000 of savings, the remaining gap is $1,550.
Without the lump sum the gap would be $16,550. The bigger exposure is lost income, not the hospital bill.
On Original Medicare with no supplement, two stays in separate benefit periods would mean two Part A deductibles of $1,736, $3,472 in all, before any Part B costs (CMS).
Change one input and the picture moves. With six months of lost income instead of three, costs rise to $34,600 and, with the same benefits and savings, the gap grows to $15,350. Recovery length is the hardest number to guess, so try a short and a long version.
| Line | Amount |
|---|---|
| Medical bills | $7,000 |
| Lost income, 3 months | $12,000 |
| Extra costs, 3 months | $1,800 |
| Hospital indemnity, 5 days | minus $1,250 |
| Critical illness lump sum | minus $15,000 |
| Savings used | minus $3,000 |
| Remaining gap | $1,550 |
Illustration: a hypothetical example built from the rules and figures cited on this page, not a quote.
Mistakes when sizing hospital or critical illness cover
- Insuring the hospital bill alone. Lost wages and recovery costs often dwarf the bill your plan leaves.
- Duplicating a Medigap plan. If Medigap already pays the Part A deductible, a policy bought to cover that deductible may simply repeat it.
- Skipping the definitions. Critical illness policies pay for listed conditions under their own definitions, and many have waiting periods.
- Ignoring pre-existing condition limits. Many policies limit or delay benefits for conditions you had before buying.
- Forgetting benefits from work. Paid leave and disability coverage reduce lost income; count them before buying more.
- Assuming an Advantage maximum covers everything. The yearly limit applies to covered in-network services. Out-of-network bills, uncovered care and prescriptions sit outside it.
New Jersey benefits that shrink the gap
New Jersey workers are covered by Temporary Disability Insurance, which in 2026 pays 85% of your average weekly wage, up to $1,119 a week, for up to 26 weeks when a health condition unrelated to work keeps you from working. Some employers use an approved private plan instead. Count it before you size a policy.
On Medicare, the 2026 Part A deductible is $1,736 per benefit period (CMS). Camden County’s 2027 Medicare Advantage plans have in-network out-of-pocket maximums from $4,150 to $9,850, the realistic ceiling on covered medical bills (CMS 2027 landscape file).
Supplemental policies sold in New Jersey are overseen by the New Jersey Department of Banking and Insurance, and every policy is subject to underwriting and carrier approval.
If your employer uses a private disability plan approved in place of the state Temporary Disability Insurance plan, ask human resources how much of your wage it replaces and for how long.
Key terms: Hospital and illness gap
- Hospital indemnity
- A policy paying a set amount for each day of a covered inpatient stay.
- Critical illness
- A policy paying a lump sum when you are diagnosed with a listed condition, such as a heart attack or stroke.
- Benefit period
- In Original Medicare, a stretch that starts at admission and ends after 60 days in a row without inpatient care; each new one brings a new Part A deductible.
- Waiting period
- Time after a policy starts before some benefits can be paid.
- Out-of-pocket maximum
- The most your health plan makes you pay for covered care in a year.
Facts that make the gap estimate realistic
- Your health plan’s deductible, coinsurance, hospital copays and out-of-pocket maximum.
- Monthly take-home pay for each earner.
- Sick leave, New Jersey Temporary Disability Insurance or a private disability plan through work.
- Savings you would actually spend, and any supplemental policies you already hold.
What this assumes
- Every figure is one you enter. Nothing is filled in for you.
- For reference, the 2026 Medicare Part A hospital deductible is $1,736 per benefit period (CMS). Medicare Advantage plans use their own copays and out-of-pocket limits.
- Hospital indemnity pays a set amount per day in hospital. Critical illness pays a lump sum on a covered diagnosis. Both pay you, not the provider.
- Policies have definitions, waiting periods and limits that decide whether and how much they pay.
- Supplemental policies are subject to underwriting and carrier approval.
- An estimate from published figures and the numbers you enter, not a quote or an eligibility decision.
Where the figures come from
- CMS 2026 Medicare Part A inpatient hospital deductible Centers for Medicare & Medicaid Services, 2026
- CMS CY2027 Medicare Advantage and Part D landscape file (New Jersey rows) Centers for Medicare & Medicaid Services, 2027
- New Jersey Department of Labor: Temporary Disability Insurance New Jersey Department of Labor and Workforce Development, 2026
What the gap calculator cannot predict
- Whether a specific policy would pay for your diagnosis.
- Premiums, which depend on age, health and carrier.
- How long recovery takes.
- Tax treatment of benefits.
Call Jackie if your plan has a high deductible or daily hospital copays, if your household relies on one income, or if you are weighing hospital indemnity against Medigap. She can show how different benefit amounts move the gap.
Dental, vision, hearing, cancer, heart attack and stroke, and hospital indemnity policies are limited benefit coverage. They pay fixed or scheduled benefits, are not major medical insurance or a substitute for it, and do not satisfy the Affordable Care Act coverage requirement. Benefits, exclusions, waiting periods and premiums are set by each policy and are subject to underwriting and carrier approval.
In clients' words
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Jackie provided amazing service, very helpful, and made me feel like I understood my options and assisted in the perfect choice.
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Common questions
What is the difference between hospital indemnity and critical illness insurance?
Hospital indemnity pays a set amount for each day you spend in hospital. Critical illness pays one lump sum when you are diagnosed with a covered condition. Both pay you directly, and you decide how to use the money.
Do I need hospital indemnity insurance with Medicare Advantage?
It can help if your plan charges a daily copay for hospital stays. Check your plan’s inpatient copays and its out-of-pocket maximum, then compare what a daily benefit would pay against those costs. The calculator does that maths with your own figures.
What does Original Medicare charge for a hospital stay in 2026?
The Part A inpatient deductible is $1,736 for each benefit period in 2026 (CMS). A Medicare Supplement plan can cover some or all of it.
How much critical illness coverage do I need?
Enough to cover what your health plan leaves you plus the income and extra costs of recovery, minus savings you would use. Policies are subject to underwriting, so the amount also depends on your health and budget.
Do you need a consultation?
Tell Jackie about your current situation. Telephone, Zoom or in person, at no cost to you. Call or text (856) 727-4221.
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Content reviewed by Jackie Layser, Licensed Medicare Insurance Agent at Garden State Medicare Solutions, New Jersey, helping Medicare clients since 2008. How we source and review our content. Last updated .