New Jersey is nicknamed as the Garden State and is also popular for Jersey City where people can take ferries to visit Island Ellis, the place of the Statue of Liberty. It is the most densely populated state of the U.S. and its residents are considered healthier, as it ranks number 12 in the state health rankings. To increase their chance of staying healthy for a longer span of their life, residents should have health insurance that will increase their chance of staying healthy for long-term. new Jersey has federally run exchange where residents can enroll in exchange plans through HealthCare.gov. But by the fall of 2020, New Jersey has plans to run its own exchange having their own enrollment platform. Residents of the state then no longer would require to use HealthCare.gov. The state has a plan to operate a fully state-run exchange by 2021. By running its own exchange, the state definitely wants to have significantly more control on the health insurance market. The state will not only enjoy the flexibility to extend open enrollment period but they can also target state’s enrollment and outreach efforts in the useful manner, they can even design their own enrollment website along with their customer service center and have more regulatory control over the plans for selling in the market.
Highlights and Updates
- Open enrollment in New Jersey for 2020 coverage run from November 1 to December 15, 2019.
- Currently the state has a federally-run health insurance exchange and the residents use HealthCare.gov for enrollment but by fall of 2020, it will have a completely state-run exchange having its own enrollment platform.
- In New-Jersey short-term health plans are not available for sale.
- Three insurance carrier are offering health insurance plans in the New Jersey exchange in 2019 and they will continue to offer in 2020.
- After decrease in the average premium in 2019 insurers have proposed significant rate increase for 2020.
- 255,246 New Jersey residents enrolled in individual health plans through the exchange during the open enrollment period for 2019 health coverage.
Individual & Family Health Insurance in New-Jersey
New Jersey residents have a wide range of options in terms of health insurance plans available for individual and families. Residents can purchase these plans either through private insurance companies or through the federal healthcare exchange. All qualifying Individual and Family plans offered by private insurance carriers should offer ten standardized essential benefits along with some additional benefits mandated by the state. The ten standardized essential benefits include emergency services, prescription drugs, hospitalization, maternity and newborn care, ambulatory services, mental health and substance use disorder services, pediatric service, preventive and wellness and chronic disease management along with rehabilitative and habilitative services.
Some of the additional benefits mandated by New Jersey include Home health care services, diabetes care management, cancer treatments, prescription and off-prescription drugs, hearing aids for children of 15 years or under, and sickle cell anemia. As per the Affordable Care Act, all qualifying Individual and Family health plans must be one of four metals like bronze, silver, gold and platinum. Insurance companies participating in the federal or a state healthcare exchange in New Jersey should offer at minimum Silver and Gold plans. Premium charged for any of the qualifying individual and family metal plans are based on the individual’s age, tobacco use, location where the individual lives and the number of family members enrolling in the plan. Individual and family health plans cannot denied coverage or charged significantly higher premiums due to pre-existing conditions or gender under ACA. Insurers cannot imposed look-back or waiting periods and plans are effective on issue.
The following types of individuals and families health insurance plans are available in New Jersey:
PPO – PPO plan is best for individuals who like to have flexibility while choosing healthcare provider or medical facility for fulfilling their healthcare needs. Members of PPO plans do not have to get referrals before visiting a specialist. Due to the freedom and flexibility offered, it is regarded as the most popular Individual and Family health plan. Though, the members are encouraged to use the insurance company’s network of doctors because healthcare services are covered at a higher benefit level than out-of-network services. Members of the PPO plan are required to pay an annual deductible and may also have a co-payment or need to pay a certain percentage of their medical bills but still this plan is hugely popular among the people.
HMO – HMO plans covers a wide range of healthcare services, as this plan has a network of healthcare providers, who have agreed to render medical services to the members of the plan. HMO plans have a broader range of coverage for preventive healthcare services compared to any other Individual and Family health plan. HMO plan members are required to choose a primary care physician, who take care of their healthcare needs and also provide a referral if the members need to visit a specialist. HMO plans are often recommended to individuals who want to purchase a plan with lower premiums and no deductible. Individuals who need preventive care services like coverage for checkups and immunizations prefer this plan, as the plan has lower out-of-pocket healthcare expenses.
HSA – Residents of New Jersey who are enrolled under a high-deductible plan are allowed to open a Health Saving Account, which is solely used to save money that can be used for future medical expenses. Amount from this account that are used for medical expenses of the account-holder or his/her dependents are non-taxable. Account holders after the age of 65 may withdraw all funds without any tax penalty.
Flexible Spending Accounts – Flexible Spending Account is a saving account established by employer to generate funds for future medical expenses. With a FSA, account holder technically owns the account and makes regular contributions through paycheck deductions and the amount saved in the account is not taxable, though the annual contributions cannot exceed $2,500. The amount saved in the account is usually used to cover diverse medical expenses and medications than what is funded by HSA. Account holders of this account should make use of the fund while it is active. However, amendments were made to allow change the plan that allow employees to roll over the amount to $500 of an unused fund into the next plan year without losing the maximum FSA contribution.
Short-term Health Plans in New-Jersey
Though federal health insurance regulations have rolled back restrictions on short-term plans but still this plan is not for sale in New-Jersey. Short-term plans are not available in this state because a New-Jersey statute that governs individual health plans has included certain requirements, which are not compatible with the plan, therefore short-term coverage is prohibited in the state and this plan has been banned in the state for the last 25 years. This is not likely to change any time soon in the future, as the New Jersey Department of Banking and Insurance has commented that New-Jersey’s ban of short-term plans would continue despite of any changes in the federal level.
Dental Insurance Plans in New Jersey
Like any other states of the U.S. New Jersey too have few federally defined dental plans offering a prescribed series of benefits for children up to age 19. Adults looking for dental plans for themselves and their family need to purchase dental plans from private companies. There are some leading dental insurance carriers in New jersey that offer best dental coverage to individuals and families as per their budget and requirements. In new Jersey there are three types of dental plans available that include:
PPO Dental Plans – PPO dental plans have a specific network of participating dentists to whom plan members can visit to avail dental care. All the participating dentists of the network agree to negotiated rates with the insurance company that considerably bring down the dental care costs for the members of the plan. Though, the members of PPO plan can visit out-of-network dentist but it will certainly increase their out-of-pocket costs.
Indemnity Plans – Indemnity dental plans come with the flexibility of visiting any dentist of one’s choice. However the insurance carrier will only pay reasonable cost of the received dental care by the members. The members of this plan need to submit their claim to the insurance company after visiting a dentist. The insurance company then cross-check the cost with their network providers and they only pay benefits up to what their network dentists would have charged. The members are responsible to pay the remaining balance.
Dental Discount – Though it is not exactly a dental insurance plan but members enrolled in this plan receive certain discounts on dental care when they visit the dentists within the plan network.
Vision Insurance Plans in New-Jersey
New-Jersey has rolled out state-level health insurance mandates that require residents to have coverage for basic care. Basic coverage that includes ten essential health benefits requirements of the Affordable Care Act that includes vision coverage for children only and not for adults. This leaves many Individuals and families in New Jersey uninsured or partially insured for vision care. Thus, individuals and families who don’t have full coverage for vision care through their health insurance plan can choose a vision care insurance plan from an insurance carrier.
Insurance carriers offering vision plans in New Jersey include:
VSP – VSP insurance carrier in New Jersey is offering three vision plans aimed at annual vision care and a plan with a lower monthly cost that offers new glasses every alternative year. The Standard plan offered by the VSP costs about $15 per month for an individual and provides annual eye exams with a $15 copayment. It is the largest vision benefits company of the U.S. having huge network of eye-doctors.
Davis Vision – This insurance carrier has expansive network having over 93,000 service providers throughout its coverage areas. The company offers several vision plans in the state but its Premier vision plan is most valuable available under $14 per month for individual coverage.
Humana – Humana is a popular choice for vision care in New Jersey, as the company’s Vision Focus plan offers annual eye exams only with a $10 copayment. Standards contact lens fittings are $40 and frame allowance is capped at $100 for in-network providers for above $100 covered by a 20% discount.
Horizon Blue – This insurance company offers two vision plans under $14 per month for individuals. The company also offer family plans and both the plans offer annual exams with a $10 copay along with frame and lens benefits available once every year.
Insurance Carrier in New Jersey
There were three health insurance carriers offering health plans in the New-Jersey exchange in 2019 and they will continue to offer health plans in 2020 too. The three carriers of New-Jersey are:
- Horizon BCBS
- Oscar Health