Affordable Health Insurance in New Jersey

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Best Medical/Health Insurance New Jersey

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.

Top Health Insurance plan in New Jersey

  • Oscar Garden State Insurance Corporation

    Simple Secure (Free 24/7 Telemedicine + Free Preventive Care)

    premium $222.92/mo

    Deductible $8150/yr

    Coinsurance7%
    Insurance Type EPO
    HSA Eligible No
  • AmeriHealth New Jersey

    IHC Bronze EPO HSA AmeriHealth Advantage $25/$50

    premium $251.68/mo

    Deductible $3450/yr

    Coinsurance6.3%
    Insurance Type EPO
    HSA Eligible Yes
  • Horizon Blue Cross Blue Shield of New Jersey

    Horizon Advantage EPO Essentials

    premium $258.79/mo

    Deductible $8150/yr

    Coinsurance4%
    Insurance Type EPO
    HSA Eligible No
  • AmeriHealth New Jersey

    IHC Local Value Simple Saver

    premium $267.81/mo

    Deductible $8150/yr

    Coinsurance3%
    Insurance Type EPO
    HSA Eligible No
  • AmeriHealth New Jersey

    IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75

    premium $268.7/mo

    Deductible $3450/yr

    Coinsurance5.5%
    Insurance Type EPO
    HSA Eligible Yes

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 vision plans in the state but its Premier vision plan is most valuable available under $14 per month for individual coverage.several

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:

  • AmeriHealth
  • Horizon BCBS
  • Oscar Health

FAQ on New Jersey Health Insurance

Yes, All the residents of New Jersey state are required to have health insurance. The state has ensured that health insurance is available and affordable to all residents. As the New Jersey health insurance mandate was enacted on November 21, 2019, so all the residents of the state under this mandate are required to have health insurance. Individuals and families residing in the New Jersey state should have at least a minimum of essential coverage. New Jersey residents who don’t have coverage through their employer, and who don’t qualify for government-funded programs like Medicare and Medicaid need to sign up for a health plan or they would face a penalty of 2.5% of their household income or pay a penalty of $695 per adult and $347.50 per child, whichever is higher. Every resident of the state who doesn’t have health insurance is supposed to pay the penalty unless they qualify for an exemption. The state has imposed penalties just to make sure that every citizen has health insurance and there are more health plans available for consumers to choose from. The fund that the state collects from the penalty amount lower the cost of health insurance for individuals.
Open enrollment is the annual period during which individuals can either enroll in a new health plan or make changes in their existing health plans. The Open enrollment period for the plan year 2021 is November 1, 2020, to January 31, 2021. This is the only time during the year when residents can enroll in a health plan or make changes in their existing plans. Outside this open enrollment period, only residents having a qualifying life event are allowed to enroll in a health plan. This is the longest extension that any state-run exchanges have issued for the upcoming open enrollment period.

No, short-term health plans are not available for sale in New Jersey, despite changes in the federal rule that rolled back restrictions on short-term health plans in 2018. Short-term coverage is prohibited in the state because a statute that governs individual health insurance plans includes requirements that are not compatible with the short-term plans. For the last 25 years, the short-term plans are not sold in the state.

While shopping for a health insurance plan, every individual tries to purchase the best and cheap health insurance plan in New Jersey. Though, the premium of the health insurance plans depends upon factors like applicant’s age, health conditions, and area. Still, some of the health insurance plans are considered as the cheapest and affordable option for a majority of the people in most of the counties of New Jersey. The cheapest health insurance plan in most of the New Jersey counties are either the IHC Silver EPO AmeriHealth Advantage $25/$50 and IHC Silver EPO HSA AmeriHealth Hospital Advantage $50/$75.

Though the cost of the health insurance plan depends upon the applicant’s age and the type of plan one chooses. To help people find the cheapest health plan in each metal tier, InsureMeNow has compared different health plans available in the state marketplace and determine the following cheapest plan in each metal-tier:

  • The cheapest Catastrophic plan for a 40-year old in New Jersey in 2020 is Oscar Simple Secure plan having a monthly premium of $272.
  • The cheapest Expanded Bronze plan for a 40-year old in New Jersey in 2020 is IHC Bronze EPO HSA AmeriHealth Advantage $25/$50 plan having a monthly premium of $307.
  • The cheapest silver plan for a 40-year old in New Jersey in 2020 is IHC Silver EPO AmeriHealth Advantage $25/$50 plan having a monthly premium of $379.
  • The cheapest Gold plan for a 40-year old in New Jersey in 2020 is the Oscar Classic Gold Option 2 plan that has a monthly premium of $647.
  • For 2021 coverage, the following three health insurance carriers are offering health insurance plans in New Jersey:

  • AmeriHealth
  • Oscar
  • Horizon
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