Obamacare in New Jersey

Health Insurance Marketplace in New Jersey

If you live in New Jersey, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

New Jersey will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $15,800 a year for 1 person or $32,500 for a family of 4. You can find out whether you qualify for Medicaid in New Jersey 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)

Find local help

Center For Family Services, Inc.

Center For Family Services, Inc. (CFS) is a nonprofit human services agency with 90 years of experience serving individuals and families across the life span. CFS will serve the seven lower southern counties of New Jersey which include: Camden, Burlington, Gloucester, Salem, Atlantic, Cape May and Cumberland. The funds will be used to educate and help enroll consumers in the health insurance marketplace.

Wendy Sykes – Orange ACA Navigator Project

The Orange ACA Navigator Project (OACANP) will integrate several successfully existing community-based systems to serve as a guide to help uninsured residents and small businesses in underserved and vulnerable populations. OACANP will help consumers learn about insurance options and assist with enrollment in health plans through the competitive health insurance marketplace.

The Urban League of Hudson County

The Urban League of Hudson County (ULHC) is a community based organization dedicated to advocating, facilitating, and promoting initiatives that allow local residents to participate in the development of urban neighborhoods. ULHC will partner with the Urban League for Bergen County, the Urban League of Morris County and the Urban League Union County to assist consumers in enrolling in the Marketplace.

Public Health Solutions

Public Health Solutions (PHS) is one of the largest non-profit organizations in New York City. PHS will partner with four community-based organizations in New Jersey to provide outreach and enrollment assistance in Hudson and Essex Counties.

FoodBank of Monmouth and Ocean Counties, Inc.

The FoodBank was created in 1984 and today serves over 260 pantries, soup kitchens and other feeding programs with almost 7 million pounds of food distributed annually. With the help of roughly 1,000 volunteers each year, the FoodBank’s programs work to eliminate hunger by providing emergency food, skills training, outreach programs and advocacy for families in need. Their work will help connect uninsured and underinsured individuals with information about their health insurance options.

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.

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Consumer Operated and Oriented Plan Program

Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets.  CO-OP’s in New Jersey:

Health Republic Insurance

Accountable Care Organizations in New Jersey

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

Health care facilities where Innovation Models are being tested

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in New Jersey

On December 7, 2012, Governor Chris Christie (R) vetoed A 3186/S 2135, which would have established a health insurance exchange within the Department of Banking and Insurance and announced that the state would default to a federal exchange.1Governor Chris Christie (R) vetoed similar legislation earlier in 2012.2

In 2011, the New Jersey Interagency Working Group on the ACA, led by the Health Care Policy Advisor to the Governor, had contracted with Rutgers University’s Center for State Health Policy to assist in the planning effort. In December 2011, the Center for State Health Policy released a summary of a multi-stakeholder forum convened to examine governance options for a New Jersey exchange.3 The results of the forum build on the Center’s compilation of stakeholder views of a state-based exchange released in August 2011.4 Though there was agreement that the state should establish an exchange, there was less consensus around the composition of the governing board and whether the exchange should be an active purchaser or clearinghouse.5

At the same time, the New Jersey Department of Banking and Insurance and the Robert Wood Johnson Foundation funded the Center for State Health Policy, in collaboration with Seton Hall University School of Law, to examine critical exchange design issues. The Center, completed a policy analysis of governance options and released a report recommending that New Jersey establish an exchange as a government agency, overseen by a Board of Directors with seven to nine members, and guided by insight from a larger advisory board.6 The Center released several additional reports on numerous topics: merging the non-group and small-group risk pools, establishment of a defined contribution strategy in the Small Business Health Options Program (SHOP) exchange, incorporating quality measures into exchange ratings of health plans, creation of Basic Health Plan in New Jersey, background information related to selection of an Essential Health Benefits plan, and prevention of adverse selection.7,8,9,10,11,12 The Center has also collaborated with Seton Hall University on a number of studies, including an assessment of the ACA’s impact on health coverage of New Jersey residents, an evaluation of federal and state regulation of rating factors, a comparison of the clearinghouse versus active purchaser model, and an investigation into eligibility and enrollment issues related to an exchange and Medicaid.13,14,15,16

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since New Jersey has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Horizon Blue Cross Blue Shield- HMO Access.

Exchange Funding

The New Jersey Department of Banking and Insurance received a federal Exchange Planning grant of $1 million in 2010. On February 22, 2012, the Department of Banking and Insurance also received a Level One Establishment grant of $7.7 million to address gaps in information technology and to continue the planning efforts and policy analysis of issues such as reinsurance, projected plan cost and utilization, standards for plan management, and the essential health benefits.17

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

New Jersey is participating in Medicaid expansion.

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in New Jersey beginning in 2014.

1. A 3186/S 2135. New Jersey Health Benefit Exchange Act of 2012.http://www.njleg.state.nj.us/2012/Bills/A3500/3186_R1.PDF
2. A 2171. New Jersey Health Benefit Exchange Act of 2012.http://www.njleg.state.nj.us/2012/Bills/A2500/2171_R2.PDF
3. “Summary of Proceedings. Stakeholder Forum to Discuss Governance Options for a New Jersey Health Insurance Exchange.” Rutgers Center for State Health Policy. December 2011.http://www.cshp.rutgers.edu/Downloads/9160.pdf
4. Cantor J, et al. “Stakeholder Views about the Design of Health Insurance Exchanges for New Jersey: Volumes I, II, and II.” Rutgers Center for State Health Policy. August 2011.http://www.cshp.rutgers.edu/Downloads/8980.pdf,http://www.cshp.rutgers.edu/Downloads/9000.pdfhttp://www.cshp.rutgers.edu/Downloads/8990.pdf
5. Fitzgerald B. “Countdown to NJ’s Health Insurance Exchange.” NJSpotlight. January 3, 2012.http://www.njspotlight.com/stories/12/0103/0316/
6. Jacobi J. “Health Insurance Exchanges: Governance Issues for New Jersey.” Rutgers Center for State Health Policy. September 2011. http://www.cshp.rutgers.edu/Downloads/9020.pdf
7. Cantor J. “Combining New Jersey’s Individual and Small Group Health Insurance Risk Pools. Rutgers Center for State Health Policy. December 2011.http://www.cshp.rutgers.edu/Downloads/9140.pdf
8. Chou J, et al. “Examining a Defined Contribution Strategy in the SHOP Exchange.” Rutgers Center for State Health Policy. December 2011. http://www.cshp.rutgers.edu/Downloads/9130.pdf
9. Michael M and Gaboda D. “Incorporating Quality Measures in Health Insurance Exchange Ratings of Health Plans. Rutgers Center for State Health Policy. December 2011.http://www.cshp.rutgers.edu/Downloads/9150.pdf
10. Gaboda D and Farnham J. “The Basic Health Plan Option in New Jersey.” Rutgers Center for State Health Policy. December 2011. http://www.cshp.rutgers.edu/Downloads/9120.pdf
11. Greenwood K, Ragone TA, Jacobi JV. “Implementing the Essential Health Benefits Requirements in New Jersey; Decision Points and Policy Issues.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012.http://www.cshp.rutgers.edu/Downloads/9540.pdf
12. Canto J “Preventing Adverse Risk Selection in New Jersey’s Health Insurance Exchange and the Outside Individual and Small-Group Markets.” Rutgers Center for State Health Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9510.pdf
13. Cantor J, et al. “Health Insurance Status in New Jersey after Implementation of the Affordable Care Act.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2011. http://www.cshp.rutgers.edu/Downloads/8970.pdf
14. Ragone TA. “Evaluating Federal and New Jersey Regulation of Rating Factors and Rating Bands. Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9490.pdf
15. Jacobi J. “Active or Passive: The Role of a New Jersey Health Insurance Exchange.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9530.pdf
16. Greenwood K. “The Health Insurance Exchange, the Medicaid program, and the Apportionment of Responsibility for Determining Eligibility and Effectuating Enrollment in New Jersey.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9500.pdf
17. U.S. Department of Health and Human Services Factsheet. “Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List.” (Accessed February 22, 2012) http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html

Also of interest

Provided by the Henry J. Kaiser Family Foundation