New Jersey is known for gifting the airwaves with fine entertainment centered on its locals, being abundant in factories and power plants, and inhabiting the state of Florida (home of East Coast Health Insurance). There are plenty of other reasons New Jersey is such a populous state, including the high concentration of industry, close proximity to major cities New York and Philadelphia, and possibly a bit of Jersey pride that forces many natives to stay put. Surprisingly, New Jersey is one of the healthier states in the nation, just missing the top ten, with a decent number of parks for hiking, biking, walking and other activities throughout the territory.

Residents of New Jersey have a small few health insurance companies to choose from when it comes to quality networks and reliable service. These include AmeriHealth New Jersey and Oxford Health Plans, a UnitedHealthcare company. Read on for a summarized list of plans they offer, and for pricing specific to your city or town and demographic, enter your zip code below. You may also call one of our agents at 888 803 5917 if you have any questions or need guidance through choosing the best individual health plan for you and your family.

Health Status

According the the UnitedHealth Foundation, who coordinates the America’s Health Rankings program of statistical gathering, New Jersey is the eleventh healthiest state in the nation for 2011. This rating has to do with many variables, including availability and number of primary care doctors to serve the population, as well as personal health and wellness. New Jersey ranks fairly low compared to the rest of the U.S. in its number of adult smokers at less than 15%, though 969,000 adults still smoke in the state. Other statistics fall in the middle, including the population of obese adults, which currently affects nearly 1.7 million people, and binge drinking, which is frequent among 14% of all adults.

There are other less positive outcomes, including the increasing number of adults with diabetes, now reaching 619,000 people. Also, New Jersey has a considerable uninsured population at 15% of all residents without health insurance. Public health funding is also fairly low, and immunization coverage is much less available than the majority of the country. There are also a high number of cancer-related deaths in the state. By getting a health plan or using public programs, many of these health problems could be treated and prevented. It is also essential to consider changing unhealthy habits, and adopting ones that combat the effects of many years of heavy home cooking and boardwalk food. There is also plenty of fresh produce in New Jersey, so it is important to take advantage of healthy eating options and regularly exercise, and New Jersey could see some improvements in years to come.

 

Health Insurance Plans

AmeriHealth New Jersey

  • IHC Preferred HMO plans are connected to the AmeriHealth HMO network, and therefore give you immediate benefits for no deductible and a high monthly premium. In-network physician care is offered for a $30 copay, for both primary care and specialists. Prescription drugs are available for 50% coinsurance for all tiers with a $1,500 annual limit. Other services available for a copay are emergency room visits, outpatient surgery, and inpatient hospital stays. There is no charge for outpatient lab and X-ray with Preferred HMO plans, and maternity care is also covered for a copay for both prenatal and labor/delivery hospital care.
  • IHC Standard HMO plans have the highest premiums of their HMO products, and offer comprehensive coverage for a copay and without a deductible. Some benefits include non-preventive doctor’s office visits for a $50 copay, for both specialists and primary care physicians. Preventive care is covered as soon as your plan starts for no cost, and as your plan is an HMO, you are required to receive a referral from your PCP to see other providers. All levels of prescriptions drugs are covered at 50% by the Standard Plan. Hospital services including maternity care are available for copayments ranging from $50 to $500.
  • IHC Basic HMO plans offer the same general outline of benefits as the Preferred HMO plan, but for a lower monthly rate (over $200 less), which omits pharmacy coverage. There is no deductible with Basic plans, which leaves all your care to predictable copayments. Office visits are available for a $30 copay with a PCP or specialist, with a $700 maximum on specialist care. Catastrophic coverage such as hospitalization, emergency care, and surgery is covered for various copays, and outpatient labs are no charge. Limited maternity coverage is also offered through Basic plans, with the first three prenatal visits for a $30 copay and no postnatal office visit coverage.
  • IHC PPO plans have individual deductibles of $2,500 and provide coverage at 90% after meeting the deductible on in-network care. First-dollar benefits include PCP office visits for illness of injury for a $30 copay, and specialist visits for $50. Pharmacy coverage is offered at every tier for 50% coinsurance, not subject to the deductible. Out-of-network care is also covered and no referrals are required, as the plan is a PPO. Hospital services are covered at 90% after deductible with the exception of emergency care for a $100 copay and no charge for diagnostic lab work. Maternity coverage is also offered, in addition to chiropractic and mental health care with limited visits.

 

Oxford Health Plans (UnitedHealthcare)

  • Basic and Essential EPO plans are connected to UnitedHealthcare’s Liberty Network of providers and offer care for no deductible, therefore having entirely immediate benefits. While prescription medications are not covered with the Basic plan, you receive care for 30% coinsurance on typically not covered services like mental health care and substance abuse treatment. These plans provide a copay for all hospital services, such as outpatient surgery for $250  and inpatient hospital stays for $500 per admission. Preventive care is no charge up to $600 annually.
  • Basic and Essential Enhanced EPO plans are also part of the Liberty Network and are very similar to the previous plan with the exception of prescription coverage and lower rates for office visits. To see a primary care doctor or specialist, you pay $25 for an office visit related to illness or injury. There is a separate pharmacy deductible of $500, which gives you access to generics for $20 and brand names for 50% coinsurance after the deductible. Neither of these plans offer out-of-network coverage, but UnitedHealthcare has an extensive list of providers, so you have plenty to choose from. Preventive care is offered for no charge with no limit as with the previous plan.

 

 

Public Health Options

In the state of New Jersey, as mentioned above public health programs may not receive adequate funding, but they do exist to help low-income members of the community. Residents who are uninsured and meet certain income criteria and health status requirements are typically eligible for Medicaid, CHIP, PCIP, and the State Health Insurance Program (SHIP), NJ FamilyCare. These and other assistance services help those who some individuals and families who cannot afford the cost of health insurance in New Jersey to stay covered and receiving health care. For a full list of programs in the state, visit the New Jersey Department of Human Services.

  • Medicaid: health insurance coverage for families and children with low income, as well as disabled and elderly persons and pregnant women. TO find out more about who qualifies for Medicaid, read our Medicaid Eligibility by State page.
  • NJ FamilyCare: medical insurance plans for families in New Jersey without health insurance and a very low income.
  • NJ WorkAbility: Medicaid for disabled adults who continue to work and whose income makes them ineligible for regular Medicaid.
  • Pre-Existing Condition Insurance Program (PCIP): a high-risk pool health plan, covering adults with a pre-existing condition who have been denied insurance or uninsured for over six months.

 

Health Insurance Laws

New Jersey health insurance companies have regulations that protect their business as well as the individuals they insure. One of the most important set of laws pertains to pre-existing conditions and how they are treated in the private health insurance market. In New Jersey, pre-existing conditions are defined by the prudent person standard, which includes any illness or health problem an individual has had in the 6 months prior to enrolling for health insurance – whether they have sought medical care or not. All insurers in New Jersey have the legal right to deny a person health coverage based on such a condition, or accept them for an elevated cost.

Adults with pre-existing conditions who are accepted for a plan can also be given an exclusion period of up to 12 months in New Jersey. This means the insurer will not pay for any care pertaining to the condition for their stated length of time. Elimination riders, however, are not legal in New Jersey, so the most an insurance company can go without paying for the condition is one year. Additionally, if you happen to be switching carriers and have a good record with your previous plan, your old plan can count as a credit to be used during the exclusion period.

There is another option for individuals with pre-existing conditions, as created by the Affordable Care Act. The Pre-Existing Condition Insurance Plan (PCIP) offers insurance coverage for high-risk individuals who do not have insurance or have been denied by the private market for their health. These plans are only available until December 2013, as due to the ACA all insurers will be required to cover high-risk individuals on January 1, 2014. The law protecting individuals from being discriminated against for their medical history will have a great effect on health care, and requires fair pricing and no exclusion periods.

Another important law affecting individual health insurance is guaranteed renewal. This law prevents any insurance company from terminating benefits on the ground of illness received after a person has started using their plan. Also, at the end of every term, this law states all insurers must ask if their client wants to enroll in the same plan for another year. By offering the same plan and benefits, this keeps the insurers in business and the insured individuals receiving consistent coverage. Guaranteed renewal is a part of the HIPAA law, therefore keeping in mind the interests of protecting the patient.