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How to Find the Best Part D Prescription Plan in New Jersey

March 30, 2014 By Mike

Best Part D Prescription Plans in New Jersey

If you are turning 65 soon, you have undoubtedly been bombarded with ads and marketing materials on Medicare Supplement plans, Medicare Advantage plans and Part D prescription drug plans. You have quite a few options for each of the different plans, so I have put together resources and a video to help with your selection.

There are nearly 30 Part D prescription plans sold in New Jersey and it can be incredibly difficult to find the right plan for you. In fact, the difference from the best plan to the worst can be thousands of dollars from your pocket so it is important to use the resources available to you on Medicare.gov and the NJ State website.

In this video on NJ Part D Plans, I will show you:

How to find the Part D drug finder on Medicare.gov
Enter your information into the site
How to save your information for later use. This way you don’t have to enter your prescriptions in every time you visit. You can also help friends and family
How to switch from preferred to generic and save money
How to use the NJ State Health Insurance Assistance Program to get more information on the plans available

Video on How to find the best Prescription Drug Plan in New Jersey

I used Absecon, 08201 in my search but this works anywhere in NJ and in the United States.

Steps to Find the Part D Plan For You

1) Make a list of all your prescription drugs. If you are unsure of what they are for any reason, ask your pharmacist to print your prescription drug list including the dosage.

2)Navigate to https://www.medicare.gov/find-a-plan/questions/home.aspx

On the Medicare site, you will be able to add your particular prescritpions to their list and check all of the plans formularies. Each insurance company will have a slightly different formualry so this site is extremely helpful in sorting them out.

If you are having trouble with the site, here is a short guide on how to use it. Navigating the Prescription Drug Finder

3)Now that you have run your prescriptions through the Medicare Plan Finder, you should now know the top few companies you should focus your attention on. I recommend visiting each insurance companies website and plan information to see if there are other perks involved with enrolling.

4)If you have made your Part D selection, now it is time to enroll. You can do this by contacting an agent like myself, enroll through the Medicare Site directly or reach out to the prospective company. If you prefer to contact the company directly, here is a nice list with all the companies offering Part D benefits in New Jersey.

List of Companies offering Part D Benefits in NJ

Additional Resources you may find helpful

1)Medicare and You 2015

2)NJ State Health Insurance Program

3)Information on getting extra help. NJ PAAD and Senior Gold

Low Income Subsidy

PAAD and Senior Gold

Social Security – Information on Extra Help

Read about other NJ Part D plans Medicare Supplements Here.

Horizon Blue Cross Blue Shield Individual- New Jersey Health Insurance Exchange

October 4, 2013 By Mike

Horizon Blue Cross Blue Shield New Jersey Individual Exchange Products

We’ve been waiting patiently to see what the new products will be for 2014 and there they are. All the information below was taken directly from www.horizonblue.com.

These plans listed below are being offered off the exchange. Either all of these plans or just a few will also be offered on the exchange. The benefits of going on the exchange are that you may qualify for a premium subsidy. Otherwise, its probably best to just go through your broker.

Getting a better deal on your individual coverage

Certain individuals will qualify for a premium subsidy if they purchase their coverage from the exchange. If you think this may be you, please visit healthcare.gov and go through the process. I’m just listing some basic information on who may qualify for a subsidy.

To qualify for the subsidy:

You must not be eligible for group coverage( or if you are, it must be considered unaffordable) Unaffordable means it will cost you more than 9% of your annual income
You must meet the income requirements below

Income requirements for subsidy on the exchange:

$11,490 to $45,960 for individuals
$15,510 to $62,040 for a family of 2
$19,530 to $78,120 for a family of 3
$23,550 to $94,200 for a family of 4
$27,570 to $110,280 for a family of 5
$31,590 to $126,360 for a family of 6
$35,610 to $142,440 for a family of 7
$39,630 to $158,520 for a family of 8

Remember if you think you will qualify for the subsidy, go to healthcare.gov. Otherwise contact your broker or get quotes directly on the Horizon BCBS website for the plans below. Prices will be identical regardless of you purchase it from.(website, broker, carrier direct, etc…)

Horizon Advance EPO Gold

Our Horizon Advance EPO plans provide access to a variety of doctors, specialists and hospitals. These plans provide integrated medical and pharmacy benefits, including wellness and emergency care. Members must select a Primary Care Physician to coordinate care and provide referrals to specialists who participate with the Horizon Advance EPO product. For non-emergency care, Horizon Advance EPO members can choose to maximize their benefits by using Preferred Tier 1 hospitals. Members can also access other hospital in the Horizon Hospital Network but will have higher out of pocket costs.

Copay(primary care/specialist) : $15/$30
Referrals: Yes
Coinsurance : 80/20
Deductible(single) : $1000
Maximum out of pocket(single) : $2,500
Prescription: $10 Generic | 60/40 Brand | 50/50 Non Formulary

Horizon Advance EPO Gold

Horizon Advance EPO Silver

Copay(primary care/specialist) : $30/ 30% after deductible
Referrals: Yes
Coinsurance : 70/30
Deductible(single) : $1500
Maximum out of pocket(single) : $5,000
Prescription: 30% Coinsurance After Deductible

Horizon Advance EPO Silver

Horizon Advantage EPO Silver

Horizon Advantage Exclusive Provider Organization (EPO) health plans offer members the freedom to use any of the thousands of participating physicians, hospitals and other health care professionals in the Horizon Managed Care Network without referrals. This plan also has access to wellness and discount programs.

Horizon Advantage EPO plans offer:

Lower premiums with flexible coverage.
No need to choose a PCP.
Out-of-network benefits for emergency care.

Copay(primary care/specialist) : $25/ $50
Referrals: No
Coinsurance : 60/40
Deductible(single) : $2000
Maximum out of pocket(single) : $6350
Prescription: $15 Generic | 60/40 Brand | 50/50 Non Formulary

Horizon Advantage EPO Silver

My Video Review of the Advantage EPO Silver Plan from Horizon

Horizon Advantage EPO Bronze

Horizon Advantage EPO plans offer:

Lower premiums with flexible coverage.
No need to choose a PCP.
Out-of-network benefits for emergency care.

Copay(primary care/specialist) : $30 / 50% Coinsurance after deductible
Referrals: No
Coinsurance : 50/50
Deductible(single) : $2500
Maximum out of pocket(single) : $6350
Prescription: 50% Coinsurance

Horizon Advantage EPO Bronze

Horizon Advantage EPO Essentials

This plan is designed to protect against financial ruin from uninsured medical expenses from hospital stays, surgeries, intensive care, diagnostics and other fees associated with an unexpected major illness.

To keep the premium cost low, the plan includes high deductibles, which means that it does not pay for routine doctor visits, prescription drugs or non-life threatening trips to the emergency room.

This plan may appeal to younger, healthy people who don’t feel they need to pay for frequent medical services but who want the peace of mind that comes with knowing they are covered against financial “catastrophe” if afflicted with a major illness

Copay(primary care/specialist) : 3 visits per year at 100% – after that you pay 100% up until deductible
Referrals: No
Coinsurance : 100% after deductible
Deductible(single) : $6350
Maximum out of pocket(single) : $6350
Prescription: You pay 100% until deductible is reached. You pay nothing after deductible.

Horizon Advantage EPO Essentials

Read about other Horizon BCBS Individual Plans here and all IHC plans.

New Jersey Health Insurance Marketplace

September 18, 2013 By Mike

New Jersey Health Insurance Exchange Update

Open enrollment will be starting up soon for the insurance marketplace here in New Jersey and there are still a lot of unanswered questions to what plans and carriers will be available. With only a few weeks to go and nothing set in place, I wonder what kind of success it will be in the first year. Anyway, I will summarize what I know so far to help clear up some questions you may have.

NJ Health Insurance Options for 2014

In 2014, individuals and small business will be able to purchase their health insurance both on and off the health insurance marketplace. In addition, both options will allow you to go it alone or use your current broker as long as they are certified to use the exchange. (I am certified.)

Individual Marketplace Carriers and Plans

From what I have heard, there will only be three carriers in New Jersey offering plans on the exchange. They will be Horizon BCBS, Amerihealth and plans offered through Freelancers Union which is the new kid on the block.

The plans will be based on metallic tiers to hopefully make it easier for everyone.

Platinum 90/10 Cost Sharing
Gold 80/20 Cost Charing
Silver 70/30 Cost Charing
Bronze 60/40 Cost Sharing

One downside to the exchange is that it won’t have the same number of options that you can get off of the insurance exchange. For example, the carrier may offer 16 plans off the exchange and only 4 on it. So you need to weigh that out when you are choosing your insurance plan.

Premiums on the NJ Marketplace

The major benefit to using the exchange, and your broker should help with this, is getting certain tax benefits you may be eligible for.

Individual

Depending on your income and other qualifications, you may be entitled to a reduction in premium on your individual plan. This discount be available off the exchange.

Small Business

If your business is taking advantage of using the recent IRS reabates, you may be entitled to a 50% rebate instead of the current 35%. To get the rebate, you need less than 20 employees, average salaries under $50,000 and contribute at least 50% of the premium as the employer. Read more about it here.

Insurance Plans Off The Exchange

Like I mentioned above, there will definitely be more options to purchase your insurance off of the exchange so you need to carefully weigh your options. Insurance companies are now revamping their product lines so they have all the essential benefits covered and we will be able to see these plans soon.

Not much will change as far as your carrier options and you will still be able to purchase your insurance through Aetna, Oxford etc… even though they won’t be on the exchange.

Keep checking back for more updates on the NJ Marketplace and don’t forget to register on the Healthcare.Gov website to get their updates.

Read about NJ Individual Plans Here.

Catastrophic Health Insurance for Individuals in New Jersey

September 6, 2013 By Mike

Individuals in New Jersey haven’t had many options for catastrophic health insurance in the past few years but I’m happy to announce that there is finally a product you can purchase.

Review of the Amerihealth Individual Catastrophic Plans

There are actually two options and they are both offered through Amerihealth. When searching for the plans, neither of the plans are labeled as catastrophic coverage so you need to actually look at the plan details. These plans are marketed as EPO plans through Amerihealth. One is an HSA qualified plan so you will need to meet the upfront deductible before they pay anything. The other plan has copays for physicians and prescriptions but everything else is subject to the deductible. Both offer low price points and the only downside I can see so far is that they utilized the Amerihealth Value Network. The Value network is a subset of the larger Amerihealth network and only includes NJ doctors.

Key Features of the Amerihealth Catastrophic Plans

Low Premiums
High Deductibles
Higher Maximum Out of Pocket
Network: Uses the Value Network – NJ Physicians only (in an emergency, you always go to the nearest hospital regardless of where you are and it is typically covered without an issue)

The two plans that I will be reviewing fit all the criteria above and they are a great option for any individuals and even business to consider for a low cost plan. One of the plans is even HSA qualified!

Amerihealth EPO Option 1 $30/50%

Deductible $2500 Single / $5,000 Family
After Deductible Plan Pays 50%
Unlimited Overall Lifetime Max – means there is no limit on how much the plan will pay in claims
Primary Care office Visit: $30 Copay
Lab: 100% no deductible
Preventive Care: 100% No Deductible
Prescription Drugs: $7 Copay for Generics and 50% coinsurance for preferred. There is a $125 limit on how much you can pay for a preferred drug. There is also no deductible for the Rx.
Out of Pocket Limit: $5,000 Single and $10,000 for a family
Full Summary Here : Amerihealth Catastrophic Option 1

Amerihealth EPO Option 2 – 50% Plan

Deductible $2500 Single / $5,000 Family
After Deductible Plan Pays 50%
Unlimited Overall Lifetime Max – means there is no limit on how much the plan will pay in claims
Primary Care office Visit: 50% After Deductible
Lab: 100% no deductible
Preventive Care: 100% No Deductible
Prescription Drugs: 50% After Deductible
Out of Pocket Limit: $5,000 Single and $10,000 for a family
Full Summary Here: Amerihealth Catastrophic Option 2

Get A Quote

Amerihealth NJ – Don’t forget, you are looking at the EPO Plans.

In our office, we have signed up many people to the new EPO plans that offer catastrophic coverage for NJ Individuals. The prices are the lowest of any other plans on the market currently and Amerihealth is a great company to work with both as a broker and a covered individual. They pride themselves on being the “Health Insurance That Pays” and in my experience they hold true to that.

What is the best life insurance for seniors?

September 5, 2013 By Mike

As a senior, getting the best life insurance is easy! When I first started in insurance, we were always taught that the best life insurance is the one that is in force when you die. Meaning, it doesn’t make much difference what you have, as long as the coverage will pay the claim. That always made sense to me and it made the business easier I think. So what does that mean for you as a consumer?

Getting the Best Life Insurance as a Senior

If we stick to the advice from above, the best insurance would be whole life insurance. Whole life insurance is designed to last your entire lifetime and will pay whenever the claim may come.

best senior life insurance for final expenses — NJ Final Expense Insurance

How Much Does Senior Life Insurance Cost?

Senior Life Insurance is just a small whole life policy, usually around a $10,000 benefit that can be bought with almost no medical underwriting. But how much does it cost??

These are just for illustrative purposes. Your actual rates will be different.

These rates represent a $10,000 whole life policy

60 year old male non-tobacco – $46 per month
60 year old female non-tobacco – $36 per month
70 year old male non-tobacco – $73 per month
70 year old female non-tobacco $54 per month

As you can see women pay a bit less than men because of their longevity. Also, if you have been looking over any life insurance quotes you will notice these rates are a little higher than fully underwritten life insurance. The reason is simple. The insurance companies are offering you a small final expense policy with little or no medical questions or exams so in return they must have slightly higher rates. They are taking both sick and healthy people so they adjust accordingly

Best Company for Final Expense Insurance

It depends.. When you call or email me for a quote, I will ask you some basic questions and we will see which company will be the best fit. If you have had serious medical issues in the past, that is no worry either as some companies are guaranteed issue with no medical questions asked.

Please email or call me for more information or you can read more about Life Insurance Here.

If you are also in the market for pricing out your Medigap plan, please read my resources

How to Get Dental Insurance in 5 Minutes – Dental Insurance for Seniors and Individuals

October 8, 2012 By Mike Sheeran

This will be a quick guide to get the best dental insurance at an affordable price. You can do it all in about 5 minutes!

This will cover dental insurance for seniors and the best indivdual insurance for individuals. I’ll also show you how to package your health and dental coverage and include vision coverage too if you need it.

Five Minute Guide to provide:

Best Dental Insurance For Individuals
Dental Plans for Seniors
Affordable Dental Insurance
Or anyone else that needs dental insurance

If you fit the above criteria, here is the plan I recommend.

Horizon Individual Dental for New Jersey Residents

Full Horizon BCBS Summary Here: Horizon Individual Dental

How much is the dental insurance?

$180 per year per adult
$68.40 per year per dependent child

That comes to about $15 per month for an adult.

Dental Coverage Details

12 month contract – you pay for the full year upfront
You must select a primary cary dentist from the list – Horizon Provider Directory
Preventive and Basic Care is covered 100%
Major Services are covered with a 30% discount in year one
Major Discount changes to 40% in year two and 50% in year three
Very affordable and one of the few plans available to New Jersey residents to purchase as an individual

Look Good? Get the Dental Coverage Started in Five Minutes

Download the Individual Dental Kit – this is a fillable pdf – Keep this open.
Look up a primary care dentist and write down the code or put it directly into the kit you just downloaded – Horizon Directory – use the advanced search options to select “Horizon Individual Dental” from the plan options. This will only search dentists accepting this plan.
Finish filling in the rest of the applicatoin that is in the kit.
Print sign and mail.
That’s it. If you mail it in before the 15th, the coverage will start on the 1st of th next month. If after the 15th, it will start the following month.

Package Health and Dental Coverage

If you are also needing individual health coverage, we can take care of that too.

Your options for individual health:

COBRA or NJ Continuation
Individual Health Program – Horizon BCBS – Amerihealth – I would look at the Amerihealth PPO, Horizon Direct Access Plan A and the EPO Plus Plan
Medicare with Medicare Supplement and Part D – NJ Medigap
NJ Protect – if you have been without coverage for over six months.

Need Vision Coverage Too?

Go direct through VSP Insurance and purchase an individual vision plan. These are a great deal and just as easy as setting up the dental.

Get VSP Coverage for Individuals