NJ Insurance Plans - Mike Sheeran, CFP

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Review of Horizon Blue cross Blue Shield Individual Health Insurance Plans

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Review of Horizon Blue cross Blue Shield Individual Health Insurance Plans for on and off the HealthCare Exchange

horizon bcbs nj

As of January 1, 2014, Horizon Blue Cross has release 5 brand new plan offerings to New Jersey residents. In my video review i will cover:

  • Brief Summary
  • Network Differences
  • Copays
  • Tier 1 and Tier 2 Difference

If you need a quote, please contact me, or feel free to reach out directly to Horizon BCBS.

 

Plans Available This Year:

Also, please visit my YouTube page for NewJerseyInsurance plans where I will be continually adding new topics for NJ health insurance.

Review of the Horizon Blue Cross Blue Shield Individual Health Insurance Exchange Plans for 2014

Horizon Blue Cross Blue Shield Individual Plan Review

Read more about Horizon Individual Health Plans and NJ IHC.

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

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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

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) : $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 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) : $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

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

New Jersey Health Insurance Marketplace

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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.

Healthcare.Gov
Healthcare.Gov

Read about NJ Individual Plans Here.

Catastrophic Health Insurance for Individuals in New Jersey

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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

New Jersey catastrophic health insurance from Amerihealth

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.

 

New Jersey Health Insurance Exchange

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Tonight the NJ Senate passed the NJ State Health Insurance Exchange Bill. The news is exciting for many New Jerseyans as it shows some promise for lower premiums in the future. The NJ Health Insurance Exchange bill will create an online marketplace for individuals and businesses to review all of their options in one place. In addition to making it easier to purchase insurance, the goal is bring down the prices for insurance in NJ. This would be fantastic as I have personally seen many companies rates that have doubled or tripled in the past five years.

Now before we all get googley eyed over the new bill, I have some concerns over how much the exchange can actually help our high NJ Health Insurance premiums woes.

New Jersey Health Insurance Exchange – Concerns

  1. What does affordable health insurance mean? In my opinion, this really needs to be answered with real numbers and not just saying “it’s more affordable”. If they an bring an HMO monthly premium from $600/month for a single down to $400/month, that would be quite a feat. At $400 a month though, is it affordable enough for people to buy? Maybe yes, maybe no?
  2. How do they expect to to bring down price levels to affordable levels?
  3. When merging the individual market with the small group, how much can we anticipate rates to go down?
  4. Just because we can purchase online, (we can already do this) why is it now magically less per month? And how much less?
  5. Competition is great and this should also help bring premiums down. But, how much??? There will be more companies trying to get their rates down with aggressive contracts with their physician networks and also by spending their money more efficiently. Should we expect smaller networks, more troubles getting services approved? How much less can we pay the doctors before they just give up and quit?
  6. Many small businesses rely on brokers to lend a helping hand with managing their plan. Will brokers be playing a major part in the exchange? If not, businesses must be trained and prepared to handle NJ Continuation, COBRA, claims, quoting, compliance, adds, changes, terminations of employees etc… Brokers act as an additional human resources department for many of the smaller businesses without a large office staff.
  7. New Jersey Protect was recently added to the NJ portfolio and it’s goal was to provide more affordable coverage. How many people have we actually enrolled in this program? My guess is not many. I give people premium rates for these plans almost every day and the response is always the same, “too much money”.  NJ Protect is considerably less in premium per month than the standard individual plans.

It may seem that I have a bad feeling about the exchange, but really my concern is with how much premiums are going to be. Are we just adding one more program that nobody can afford? New Jersey has a very large uninsured pool despite that fact that we have NJ Family Care, Medicaid, Medicare, individual health, NJ Protect, small group health, large group health, NJ Continuation, COBRA, DU31, Dep-26 and I’m sure there are even more programs. Basically, if you have the money, you can have insurance.

What I do like about the exchange is that it will certainly make it easier to understand the different programs and options. A singular place to look for insurance will be very helpful especially with the different eligibility requirements for each of the plans.

If you have an opinion on the New Jersey Insurance Exchange or think my ideas are completely wrong or misguided, I would love to hear about it.