It’s important that you, as a New Jersey resident, have an affordable and comprehensive health plan for you and your family. But which plan is the best plan for you and yours? An ACA plan is a great option for most, but these insurance products may not be for everyone. It’s in your best interest to sit down, learn what you can about what’s available, and make the best decision based on your unique medical needs and costs. We hope that the information we have collected here on this page can give you everything you need to know to make a quick and effective decision. To learn more, just keep reading.
Major Medical Insurance in New Jersey
Ever since 2014, the go-to product for health insurance in America has been a major medical health insurance plan through the ACA Health Insurance Marketplace. The Patient Protection and Affordable Care Act was passed back in 2010, and it established the ACA Health Insurance Marketplace in 2014. It has set up a series of laws, rules, and regulations which created unique insurance products which can only be sold and purchased through the Marketplace for individuals and families who do not have access to qualifying health care coverage from their employer.
New Jersey residents who want to shop for a Marketplace plan will be using HealthCare.gov for the final time in 2019 (for Coverage that starts in 2020). For 2021 coverage, in the state of New Jersey is preparing to start their own local, statewide exchange. Open Enrollment in the New Jersey state exchange is planned to begin on November 1st of 2020. But this move is still in the planning stages, so resources on where, how, and exactly when are up in the air.
One of the reasons major medical plans are so special is because they’re guaranteed issue. When you apply for a guaranteed-issue policy through the exchange, you cannot be rejected for coverage or charged more money for guaranteed issue insurance. But health insurance products sold outside of the Health Insurance Marketplace may still do medical underwriting, which is the opposite of guaranteed issue. ACA Insurance, however, must accept every approved applicant for coverage and can only charge you more for your monthly premiums based on the following four factors:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
ACA plans are also more comprehensive, largely because every single plan comes with the 10 Essential Health and Wellness Benefits guaranteed as a part of every policy. Most of these types of coverage aren’t sold outside of the marketplace, or they are sold for a very expensive premium. This is especially true for some of the most important types of coverage which people need, like preventative care or mental health counseling services:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Another attractive option that comes with most Health Insurance Marketplace plans are the federal subsidies which make them more affordable. As long as you are making at least 138% of the federal poverty limit, you will likely qualify for subsidy. If you’re making 400% or above, you might be making too much and therefore ineligible – you’ll have to pay for your full insurance premium out-of-pocket. but if you make between 400% and 138%, you could get an advances premium tax credit which makes your monthly premium substantially more affordable. For many working families and struggling adults, this can mean the difference between getting the comprehensive health insurance they need or having to go without. The chart below can show you, based on household size, where your income put you on this spectrum.
|Household Size||Annual Income (138% of FPL)|
So what happens to the people who make less than 138%? The good news is that New Jersey has accepted federal funds to expand Medicaid to those low-income individuals. But the problem with Medicaid in New Jersey is that, unlike federal subsidies for an ACA plan, there are more qualifications you must meet other than being low income and having a basic need for healthcare. For more information about what those qualifications are and whether or not you might be eligible, it’s a good idea to go ahead and visit the NJ Medicaid website.
Short Term Health Insurance in New Jersey
There currently aren’t any short-term health insurance policies available for sale within the state of New Jersey. Each state is allowed to pass its own unique laws and regulations with regard to insurance within their borders. New Jersey recently passed some laws which were designed to make short-term health insurance more similar to major medical coverage for the ACA. Unfortunately, many of those regulations made it difficult for short-term health insurance companies to generate profits from the sale of their insurance products. So most insurers chose to close up shop and sell insurance in states which are more favorable to them.
Most of the time, this happens because states want to pass laws which force short-term health insurance companies to offer guaranteed issue policies, to offer all of the Essential Health Benefits mentioned above, or both. This cuts into insurance companies’ profits because it forces them to offer coverage to people who could cost them more to insure then they get in profit from collecting monthly premiums, co-pays, and coinsurance. And offering additional benefits, especially expensive ones like mental health counseling, encourages customers to seek medical care more often and get more expensive medical care. Paying for these also costs a lot of money for health insurance companies, which is one of the reasons why they don’t like to offer these services unless they absolutely have to – even if it would make their customers healthier and happier in the long run.
Christian Health Plans/Health-Sharing Plans in New Jersey
Since short-term health insurance isn’t available in the state of New Jersey, your next best option is a Christian health plan, sometimes referred to as a health share plan. These plans are especially popular in New Jersey not just because of the lack of short-term health insurance – but also because of how useful they were while the individual mandate was still law. Christian health plans offered a religious exemption to the individual mandate back when Americans had to either purchase qualifying major medical coverage or pay a tax penalty. Now that Americans are no longer legally required to purchase insurance and can choose to go without, some choose to do so – but others are rightfully concerned about the catastrophic amount of medical expenses they might face without coverage if an unexpected medical emergency happens.
Health share plans are their own, unique type of coverage – but that being said, they still have quite a few things in common with short-term health insurance. Those similarities include:
- These plans are NOT guaranteed issue
- They have unlimited out-of-pocket costs
- They have lifetime and annual benefit caps
- They likely won’t have all of the guaranteed essential health benefits
Now let’s talk about the differences that make them unique and separate from short-term health insurance. Almost every single one of these plans is managed by a religious organization, which means that they can’t be regulated as closely as something like short-term health insurance. This means they don’t have to comply with laws that say they need to offer guaranteed issue coverage or specific health benefits. So keep in mind that you will have to undergo medical underwriting, you might not be able to purchase all of the coverage benefits you would like, and you also won’t have a right to legal recourse if your plan provider refuses to pay out on claims. You will have to settle your differences with the organization itself. You will also be expected to follow participation guidelines which usually include declaring a specific (Christian) faith and adhering to other lifestyle choices which are inspired by biblical teachings. Instead of paying a monthly premium, you’ll be paying a “monthly share amount” for your health share plan; likewise, you’ll be paying an “unshared amount” or a “shared member responsibility amount” instead of things like co-pays, deductibles, or coinsurance.
Fixed Indemnity Plans in New Jersey
Fixed indemnity plans aren’t typically sold as a replacement for major medical coverage – but if you’re desperate and short on options, you might be considering it. Before you do that, you should know that these plans work much better as a form of supplemental coverage instead of a replacement for major medical. This is because major medical insurance policies agree to cover a certain percentage of your total medical costs – usually starting at about 60%, or more depending on the tier – while a fixed indemnity plan only pays a fixed amount, regardless of the care you get or how frequently you use it.
Fixed indemnity plans pay out claims based on a per day, per week, per month, per incident, or per visit basis. A fixed indemnity plan may only apply to hospital expenses, doctor visits, dental care, or some combination depending on who your provider is and how flexible they are with letting you craft your plan. Like a christian health plan, indemnity plans come with lifetime and annual caps on your medical benefits, but no caps whatsoever on your total out-of-pocket costs. But if the monthly premiums for an indemnity plan are all you can afford, you can at least somewhat reduce your out-of-pocket costs in the event that you suddenly require a lot of unexpected medical care. These policies are also not guaranteed issue, so make sure you are healthy before you decide to purchase one – or else they could cost a pretty penny.
Discount Cards in New Jersey
You have different options when it comes to medical discount cards in New Jersey. There are many different types of medical discount cards – some of them cover a plethora of different medical services, some of them only cover one specific type of medical care, and some of them, like the New Jersey drug card, only help with prescription drug costs. Unlike most other medical discount cards, the New Jersey drug heart is free and available for anyone who wants it. You can get coupons and use them to save up to 75% off of your prescription drug costs without having to fill out an application or qualify for anything. You can learn more about this offer at the New Jersey drug card website.
If you want something more comprehensive, and if you’re willing to pay for it, you might want a different type of medical discount card. These cards work similarly to other membership programs like AAA or the AARP; you request information, you fill out an application which usually includes a membership fee, and then they send you a card in the mail. You present that card at participating retailers and doctors’ offices in order to get discounts off your medical costs. But these cards are not insurance, and anyone who tells you otherwise is most likely lying and trying to scam you. Some companies may be honest about the fact that they are not selling you medical insurance when they sell you a medical discount card, but may still be less than honest about what discounts you can get, and who you can get discounts from. It’s best to do a little digging and call around to confirm the discounts in the provider’s they quote you. If everything checks out, and if it looks like you can save more money on discounts then it will cost you in membership fees, then medical discount cards can be an excellent way to help you keep your out-of-pocket costs under control. But if anything sounds too good to be true and you get a bad feeling about it, then be wary.