Mike

Network Comparison 2018 – Amerihealth vs Horizon BCBS

November 8, 2017 By Mike

Hi everyone, just a short video comparing the networks of Horizon BCBS and Amerihealth.

Video Transcription via Rev.com

Mike: Hi everyone, it’s Mike for NewJerseyinsuranceplans.com. Today I’m going to go over the network differences between Horizon Blue Cross, and Amerihealth. Now, the reason I’m going over this is that, a lot of the plans within our Horizon Blue Cross and Amerihealth, they sound very similar. For example, Amerihealth has a plan called their Advantage plan. Horizon has a plan called their Advantage plan.

As far as our network is concerned, they are very different plans. So today I wanna go over how the different plans work and also compare that their Omni plans within Horizon. And the first screen you’re looking at here is something I will make available. But it’s just a spreadsheet I made, and these are the individual plans in New Jersey for 2018.

So, I combined all the rates into one spreadsheet, and then down at the bottom here I have some links where you can download the plan guides, and the rate sheets and applications if you need them. Now, we’re just gonna look at everything in one spot, and you can scroll over and pull your age and the price for whatever plan you’re looking at.

So, the first carrier I’ll go over will be Amerihealth. And within the Amerihealth plans, you’ll have access to a few different networks. So, the first one and what I call their normal network is called, Regional Preferred. Now, with the Regional Preferred network you can see you have all of New Jersey, you’ll have part of Delaware, and part of the Philadelphia region. So this would be your teaching hospitals in the Philadelphia region.

So, Jefferson Penn, Chop, you know all the big ones that you would tend to go to in the Philadelphia region. Now, Amerihealth also sells some lesser priced plans that are part of their local value network. So the local value network is about 82% of their New Jersey based hospitals. As you can see how it’s highlighted here. You can only go to New Jersey.

So that’s something pretty big to keep in mind because when you’re looking at the prices and comparing them to Horizon, it’s always not apples and apples. If the price is close, you have to make sure you’re not looking at a local value plan and comparing it to one of the plans with Horizon, where they may have the full network. So as we go down the list, we can continue down to their Amerihealth Advantage series, or their tier one Advantage series.

With Amerihealth Advantage, you have to live in one of these Highland counties, and you can receive a lower premium for your plan. If you purchase one of their tier one Advantage plans, you can see here that it’s still all of New Jersey, and you can pay a lower co-pay if you use what they consider a Tier one provider. So, you can go on their network and look up to see where your provider falls and if they’re considered Tier one and pay a low co-pay. So it’s not so bad.

Now if we look at the Horizon Blue Cross plans, you’ll notice some similar names down. Now these are the small group networks, they will work exactly the same as individual. So I’m just going to show you here. So, within Horizon Blue Cross you have what they call their Omni network, and you have what they call their Advantage network.

So this is one of the guides I also make available on that link you saw here. So, for 2018, these are the Advantage series plans within Horizon Blue Cross, and they have their Advantage Silver, which is what they’ve had for years. They have their Advantage Bronze, which is new for this year, and Advantage Essentials. Now, unlike Amerihealth, Horizon Blue Cross’s advantage plans have access to their full network.

So you can go anywhere in New Jersey that’s in network, anywhere in the Philadelphia region that’s in network, New York, parts of Delaware. It’s their full network. You don’t need a referral for these plans. You don’t have to worry about anything being Tier one or Tier two. You just use the network. Very simple. Now they … A few years ago, they came out with what they call their Omni plans.

Now with their Omni plans, the network is identical in every way. So, if a doctor takes their Advantage plan, they will take Omni. What will change though, is the tier that they fall under. So, similar to Amerihealth, where they have both Tier one and Tier two, these Omni plans also have Tier one and Tier two. So you just have to look up your providers and see what tier they fall into. And you’re co-pay or co-insurance will depend, depending on the tier they refer into.

So again, just a big thing to keep in mind is when comparing rates … And I’ll go back to the rate sheet here. When you compare say, their Omni bronze HSA, that’s the Horizon plan, you can compare it to the Amerihealth plan. The prices aren’t that much different between these two, but the networks are very different. So, on this one you can use Horizon’s full network. This one here, New Jersey only and, it’s going to use the tier system.

So that’s it for today. Just wanted to go … A quick review of the 2018 networks with Horizon Blue Cross and Amerihealth, ’cause I know it can be very confusing. If you have any questions, please contact me anytime at [email protected], and have a great day. Thanks. Bye-bye.

Network Review of Horizon BCBS vs. Amerihealth vs. Health Republic

July 24, 2016 By Mike

NJ Health Insurance Exchange Network Review of Horizon BCBS vs. Amerihealth vs. Health Republic.- NJ

Reviewing the different plan options on the NJ Health Insurance Exchange can be difficult and the HealthCare.Gov website doesn’t always provide all of the details so today I’m going to go over the networks for each of the carriers.

In this video, I will specifically cover the networks for Amerihealth, Horizon BCBS and Health Republic.

NJ Health Insurance Carrier Options on the exchange

Amerihealth

Regional Preferred – this is their standard network that they have always used. Includes of NJ and a good part of the Pennsylvania counties near Philadelphia. The Amerihealth Regional Preferred Network includes all of New Jersey and the following Pennsylvania counties: Northampton, Lehigh, Bucks, Berks, Montgomery, Philadelphi, Delaware, Chester and Lancaster.
Value Network – this is a subset of the Regional Preferred and includes roughly 79% of their larger Regional Preferred. Please note that the only Philadelphia hospital as of today that in that network is Childrens Hospital(CHOP)
Tier 1 Advantage – Tier 1 breaks down the Value Network even further. You will pay lower out of pocket for Tier 1 hospitals compared to Tier 2
National – This is the only National Network available from the individual carriers. Amerihealth uses the Multiplan network. The national option is only available on their POS+ plans. While you are in the Regional Preferred Service area, you must use that network. So for example, if your provider in Philadelphia does not accept Amerihealth but they are in the Multiplan network, that provider would be considered out of network. If you were in a county outside of that Regional Preferred network and they took Multiplan, you would be ok.
See my sheet for looking up physicians in the Amerihealth Regional Preferred and PHCS network

Amerihealth Local Value Hospitals

Multiplan National

Health Republic

Health Republic uses the Qualcare HMO network and includes hospitals in NJ, PA and even Sloan Kettering in New York. They look to be a strong competitor network wise.

Health Republic Hospital Network

Updated 2015 Information for Health Republic

Health Republic will only be offering no-referral plans for 2015 so this is great for consumers. They will continue to use the Qualcare network in New Jersey and then the expanded PHCS Network when outside of NJ.

Please see some of their marketing materials below including

1)Health Republic 2015 Individual Enrollment Kit– this is to enroll off the exchange, so if you would like to do so, please reach out to me with the application so it can be submitted.

2)Health Republic Network PHCS Flyer

3)Health Republic Vaccine sheet

4)Health Republic Benefit Highlights Flyer[schema type=”product” name=”Health Republic Individual Health Insurance” ]

Horizon Blue Cross Blue Shield of NJ

Advantage – these plans use the Managed Care network – this is the same as you have always had if you used their HMO, POS options
Omnia – The Omnia plans are new for 2016 and you can see my write up here. Horizon BCBS Omnia Review

Horizon BCBS Hospital List

New Jersey Insurance Exchange – Network Review of Horizon BCBS vs Amerihealth and Health Republic

Read more about the comparison of these plans and other NJ IHC plans here.

Review of Horizon BCBSNJ Omnia – Everything you need to know about Omnia Plans

February 25, 2016 By Mike

Horizon OMNIA Plans

Horizon Blue Cross released their new set of plans as of January 1, 2016 and they have created a ton of press, both good and bad. I won’t go over the criticisms of the plan, but I will cover what patients and business owners need to know before enrolling in one of the Horizon BCBS Omnia plans.

*The short summary is that these are great plans that everyone should look at to save money in premiums and out of pocket costs at their providers.

Horizon BCBS Omnia Explained

Blue Cross released these plans with their major goal of providing some lower priced plans for consumers and encouraging quality of care with financial incentives to your doctors. They hand selected certain providers that have proven success of providing good low cost care and other metrics they decided were important. Some of the goals that were established were; lowering re-admissions to the hospital, infections and other costly issues that can arise through normal course of care. So if you needed surgery and have to be readmitted to the hospital in a month because of complications, the provider would not get any incentives for that. If your doctor does the perfect job every time with no infections, no re-admissions etc.. that provider would receive a financial bonus. Its good for you and the doctors. (As an aside, you would think that would be the goal anyway but…. that’s a story for another day)

Omnia Network

The Horizion Omnia network continues to be confusing to people and I can certainly understand why. All of the literature that Horizon has put out is basically just patting themselves on the back for their great new product and how great the hospitals are and other things that don’t really help with understanding the plan.

The hospitals in the Omnia plans are IDENTICAL to the normal Horizon Managed care network. So if you had HMO, Advantage, POS or EPO, your hospitals have not changed… What has changed is what Tier structure those hospitals fall into. The Omnia plans use a Tier structure so you pay less at Tier 1 providers than you would at Tier 2.. If your provider is Tier 2, you can still visit those doctors but it will be higher cost.

Horizon BCBS List of Tier 1 and Tier 2 Hospitals

Depending on if you are in a small group plan or large group, the Tiers will be slightly different. In South Jersey, there is a large difference. Atlanticare is Tier 1 for Midsize market and Tier 2 for small group. Shore Memorial hospital is Tier 1 for small group and Tier 2 for midsize.

Find your doctor:

Go to HorizonBlue.com and use their provider finder.[/vc_column_text][/vc_column][/vc_row][vc_row type=”in_container” scene_position=”center” text_color=”dark” text_align=”left” overlay_strength=”0.3″][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ width=”1/2″][image_with_animation image_url=”2693″ alignment=”” animation=”Fade In”][/vc_column][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ width=”1/2″][image_with_animation image_url=”2694″ alignment=”” animation=”Fade In”][/vc_column][/vc_row][vc_row type=”in_container” scene_position=”center” text_color=”dark” text_align=”left” overlay_strength=”0.3″][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ width=”1/1″][vc_column_text]When you are doing your search, make sure you select the plan that you have in the drop down list.

Midsize and Large Group:

Select: Omnia

Small Group and Individual:

Select Omnia Silver, Omnia Bronze etc…

Omnia Deductible and Max Out of Pocket

With the exception of the Bronze and H.S.A, the Omnia plans do not have deductibles for Tier 1 providers. You will also notice that there are different maximum out of pockets listed for each Tier.

If you see a Tier 1 provider, that service will accumulate towards your Tier 1 Max and deductible if it applies. Those costs will also cross accumulate to your Tier 2 max.

If you see a a Tier 2 provider, those costs ONLY count towards Tier 2.. They do not cross accumulate back to Tier 1.

Omnia Plan Options

Omnia Frequently Asked Questions – FAQ

Do I need to select a primary care doctor?
1. Nope, although you will pay the lower copay.
Do I need referrals?
1. No, they are all no referral plans
Can I go out of network?
1. No, this is in network only unless it is an emergency
How are prescriptions covered?
1. Prescriptions are all Tier 1
How is urgent care covered?
1. From what I have seen, all urgent care centers are Tier 1 for 2016. Even if the hospital is Tier 2..
Do I get BlueCard nationwide access?
1. The midsize plans do have BlueCard attached, but the small group and individual plans do not.
My doctor says they don’t take Omnia, now what?
1. Double check this.. Many people think that if the provider is not Tier 1, they aren’t part of the network. This is not true. Always double check with the website and ask for clarification. Get help from your broker with this.
How is it fair that Horizon can pick and choose the Tier 1 hospitals?
1. This is one of the criticisms on the plans and we will see what happens. There are many people fighting this.
What if Horizon is told they can’t sell these plans anymore because it is not fair in how they selected their providers?
1. If this does happen, Horizon will likely change the plans at renewal and you will need to select a new plan. Not much different than what they have been doing.
I’m interested in learning more, what do I need to do?
1. You can reach out to me anytime and I will review the plans and prices with you.
What is the best Omnia Plan?
1. I’m going to ignore the benefits and base my decision on the best value. Of all the plans I’ve reviewed, I like the H.S.A option and is what I personally own. The out of pocket limit is much lower than the other plans for their Tier 1 providers at $3500 annually.

Best NJ Dental Plan for Individuals and Families

August 3, 2015 By Mike

Security Life of Denver – Best Individual Dental Plans for NJ

Finding a good dental plan in New Jersey has been almost impossible up to this point for individuals and families. Yes there is the very basic Centurion Plan from Horizon and their Individual Dental Plan but they are really just ok at best. They are more along the lines of discount dental plans and not something like you would find at your employer.

Not only that, you can also purchase an Individual Vision Plan that uses the VSP Network.. Start with a quote by clicking the image above.

How the Security Life Dental Plan works in New Jersey

Plan Options

1) Essential Plan – the essential plan is basic coverage with no network restrictions. Its an indemnity plan so you can use it wherever you choose. The benefits are limited to $500 annually but your cleanings are covered 100% and Basic Coverage (fillings/x-rays) are covered at 80%. They pay 80% and you pay the remaining 20%. There is no coverage for major services on this plan.

2) Advantage Plus

The Advantage Plus plan uses the Maximum Care network so you will get the most benefit by staying in that network. In fact, if you can’t find a dentist in the network, I wouldn’t recommend the plan anyway so make sure you check that network link out.

Moving on..

What makes this plan great and the best NJ Individual Dental Plan is that the benefits are very similar to group dental plans. It offers 100% coverage for basic, and then then benefits for Basic and Major are enhanced each year as long as you keep the plan. It starts out with an annual $1,000 maximum but you can increase that amount to $2,000 by buying up. Check out the full benefits below but in my opinion, this is the best plan I’ve seen that isn’t part of an employer based plan.

Limitations

Ok nothing is perfect. The plan does have some limitations just like any dental plan.

1)Network – make sure your dentist takes it before purchasing the plan.

2)Benefit scales up as you go – If you only want the plan for a year, the benefits aren’t as attractive on the Advantage Plus plan. It gets better after year one as they enhance the benefit.

3)This is just a general limitation on all dental plans.. I get a lot of calls from people who want 100% coverage on day 1 for all their dental ailments. There is no such thing. This is because people wait until the last second to buy their insurance and then expect the insurance company to pay their $1,000 Crown and after which the person will cancel the plan.. Because of this, they uses benefit that increases over time because from a business perspective, they can’t just collect a month of premium and then pay $1,000 only for you to leave the plan a month later. Anyway, read through the benefits on their site..

How to enroll in the Security Life Dental Plan for NJ

If you think this is a good plan for you, and enroll through my link below, I am compensated by Security Life. The price is the same whether it is through me or through any other agent or even direct with the company so that is up to you on how to enroll.

They only do online enrollment which is great and means no paper forms to fill out!! They allow you to enroll any day of the month and the process seems easy and very straightforward.

If you have any questions, you can always contact me at [email protected] and if you want to enroll please use my link below.

Read about more dental plans in NJ here.

Cheapest NJ Medicare Supplement Plan F

July 23, 2015 By Mike

New Jersey Medicare – Plan F

Monthly premium ranges for Medigap Plan F are from the $150’s for a 65 year old male up to as much as $249.87. How much are you paying?

Female age 65 Cheapest Medigap Plan F in New Jersey

I just did a quick quote for a female age 65 in Absecon, NJ and these are currently the cheapest rates for Plan F. If you have someone else in the household with a supplement, these rates can go down as much as 7%. Contact me for an official quote.

Male Age 65 Cheapest Medigap Plan F in New Jersey

The above rates are for the South Jersey region. Depending on your zip code the rates could be more or less so you should always contact me first.

More Information About Medigap Plan F

It is the most comprehensive plan of any of the Medicare Supplements
The coverage is identical regardless of the carrier you choose.
I will repeat, that.. The coverage is identical regardless of the carrier. Do not overpay, just because you recognize the carrier name. We’ve sold almost all the carriers and they all work perfectly.
Some people like to purchase Plan G instead of F and I think that is also a good idea. Please contact me and I will tell you why.
Plan F is the most popular plan sold because it is easy to use and own. Not that the others aren’t as well, but with Plan F, if you get a bill from a provider, it is wrong.. Unless Medicare denied the bill and in that case, we need to take a look.
You can change your plan at any time if you see something cheaper. All you need to do is go through underwriting with some simple medical questions. If you don’t get accepted, oh well. Companies can’t terminate your coverage unless you fail to pay the premiums. Nothing ventured, nothing gained!
Any other questions, contact me. I usually email back within the hour.