NJ Insurance Plans - Mike Sheeran, CFP

New Jersey Health Insurance - Reviews and Recommendations

Network Comparison 2018 – Amerihealth vs Horizon BCBS

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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.

NJ Dental Insurance – Dental Insurance Options for New Jersey Residents

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NJ Dental Insurance PlansMost doctors would agree that regular dental checkups are important not only for your teeth but for your overall well being. Looking at NJ Dental Insurance plans is a good way to keep your costs down and make sure you can get the care you need it.

I will go over some of the things you should consider when going over the dental plan, some of the companies that sell dental insurance in New Jersey and some other tips to help you out.

horizonblue dental

NJ Dental Insurance Plan Considerations

  1. Dental Network – dental networks can be a bit tricky. A lot of times, the more established dentists will only accept the pricier dental plans. Make sure that your particular dentist is in the network or check if the plan has acceptable out of network benefits. If your dentist does not participate, you should probably skip the insurance altogether or consider switching dental providers.
  2. Plan Design – most plans fit into two broad categories. They are either discount plans or full fledged dental plans. Discount dental plans will provide network discounts for all of your services. Preventive care may be covered 100% but that will be about it. An example of this would be the Horizon BCBS Dental Companion Plan or their PPO Access Plan. A full dental plan will usually cover preventive at 100%, basic at 80% and major at 50%. Decide what level of benefits you are comfortable with.
  3. NJ Dental Insurance Pricing – If you are covered by a group plan, the discount dental options are usually around $10 per single employee and the full fledged dental plans are between $30 and $50 per month. Prices will vary with network, level of coverage etc… An example of what can make the price change can be found here in my article on the UCR and MAC dental options.
  4. Individual vs group – Small business dental plans will provide many more options than the individual dental insurance options. The only individual plans I know of are the Horizon Individual Dental plan and Horizon Dental Centurion. Compare each of your options carefully to see what may be best for you. You may personally find that an individual dental plan will suit you perfectly. See my post here for more information on the .Horizon Individual Dental Insurance Plans
  5. Dental Insurance Price vs Benefits – if you are blessed with good teeth and only get cleanings twice a year, maybe you should reconsider paying for  a plan that is $50 per month. Cleanings twice a year may cost a you a few hundred dollars with no insuranc, so keep that in mind before you spend $600 in premium. Carefully examine a typical year for yourself and compare the premium to the actual benefit you can receive.
  6. Exclusions – before you purchase the plan make sure there are no exclusions for services that you plan on getting. Not all plans cover orthodontia and most if not all won’t cover cosmetic dentistry.
  7. Dental Waiting Periods: Most plans will have a wait period for major services. These can be a year or more. If you purchase a plan to get a crown covered, you are probably out of luck unless you had prior dental coverage. The carriers will impose this wait because they know people will only buy the plan to get the major service covered and then cancel it.

How to Get NJ Dental Insurance

You can see the list of companies that sell plans below, but I have a preferred plan and insurance company. For the longest time, we had very few options in NJ for dental plans, but Security Life of Denver recently added the Garden State to their list of approved states so we now have the option.

It’s not a familiar name like Horizon BCBS or some of the others but it is really convenient to purchase and you can start a plan any day of the month. They also offer a discount plan, a full dental plan as well as vision plans through VSP and Eyemed. They have really done a good job of packaging everything together.

If you want to see more about that plan, you can check my post out and if you decide to enroll, please use my link for Security Life Dental and Vision.

 

Ready to move ahead with your Dental Insurance? Here are some companies that sell small business dental insurance or individual dental insurance.

Dental Insurance Companies

  1. Horizon Blue Cross Blue Shield
  2. Delta Dental
  3. Standard Insurance
  4. Guardian Life Insurance
  5. United Concordia
  6. Oxford Health Plans/UnitedHealthcare
  7. Aetna
  8. Assurant
  9. Aflac
  10. MetLife
  11. Security Life of Denver **Best Dental Plan for Individuals in my opinion

 

Who Should Not Buy a Dental Plan

I’m going to mention this only because this is my most common call and email.. If you were just told that you needed a root canal or crown or something expensive, every single plan will exclude these major services for at least the first six months. The reason being, is that they know people will buy the plan, get their crown paid for and then terminate.

Just like any other insurance, you need to buy it before you actually need it. No surprises here.

Also, if your dentist doesn’t take any insurance or doesn’t accept the insurance you are considering, I would hold off. There is usually some coverage for out of network services, but it makes the whole program not quite as good of a deal. In fact, you may end up spending more in this scenario after adding in the premiums. I would run the numbers and see what you are looking at.

 

 

Need more information on getting dental insurance for yourself or your New Jersey based business? Contact me here for information or a quote.

Read more about the NJ Dental Plans I sell and reviews.

Medigap Plans New Jersey – New Jersey Medicare Supplement Options

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This will be a resource post to New Jersey residents that are shopping for a Medigap Plan in NJ. These plans are also referred to as Medicare Supplement plans in NJ.

 

If you already know what a Medigap Plan is, feel free to skip ahead to the section on the rates for Medigap Plans in New Jersey

The fastest way to get the information you need is to go ahead and send me a quote request. I usually can respond within the hour or will get to you as soon as I can. Quotes are always free and I’m happy to give you my opinion on all the Medigap plans. 

What is a Medigap policy?

A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that’s designed to supplement Original Medicare. This means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy. Every Medigap policy must follow Federal and state laws designed to protect you, and the policy must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.

What do each of the different Medigap Plans in New Jersey Cover?

New Jersey Medigap Coverage Chart

See chart

Medigap NJ Chart

 

What is the best Medigap Policy to Buy in New Jersey?

Most people will purchase either Plan F, Plan G or Plan N.

Plan F: Plan F will cover all of your expenses except for prescriptions 100%. It is the easiest plan to work with because you will never have to pay a copay or worry about a bill. This means it is also the most expensive plan.

Plan G:  Plan G is identical to Plan F except you need to pay your annual Part B deductible. in 2016, the Part B deductible is $162. Once you meet that deductible, this plan will work exactly like Plan F with everything covered 100%. You can typically expect to spend about $20 less per month compared to Plan F. You will save roughly $240 and only need to pay your deductible.

Plan N: The lowest plan we usually look at is Plan N and will fall right around $40-$50 less per month than Plan F. Just like Plan G, you will need to pay your Part B deductible and then also once that is met, you will need to pay a copay of $20 at your doctor. For emergency rooms, you have a $50 copay. One last thing to note is that Plan N does not cover excess charges. Excess charges can happen if your provider does not accept Medicare assignment and it gives them the right to bill you a little extra. It is 15% above what Medicare would allow for that expense.

Which is Best?

I personally would choose Plan G, followed by Plan N and lastly Plan F.

From what I have seen for at least the five years, Plan G has much lower increases over time when compared to Plan F. You are also guaranteed to save in premium when compared to Plan F. Since plan G can only be purchased by those that are in their initial enrollment or can medically qualify, it has a healthier pool of people and thus has lower claims over time keeping the prices more stable.

 

Best Medicare Supplement for Couples

There are a few companies in NJ that offer discounts for spouses and even for people that are in the same household. My favorites are Aetna and Mutual of Omaha. If you are turning 65 and your spouse isn’t too far behind, I would look at one of these companies first. When you add in the discounts of up to 7%, it brings the prices down and puts them at the top of the list for best pricing.

 

Best Medicare Supplement Company in NJ

I often get asked which company is the best and ultimately the company doesn’t matter a whole lot. I would personally pick one of the top three for pricing, look at how recently their rates changed and factor in a few other options. I would not put any weight in the company name. AARP, Horizon and others are well known but they will not process your claim any differently than a no name company. Those two may still be your best choice at the time of enrolling, but I wouldn’t seek out anyone in particular with the exception of the companies that have the spousal/household discounts. The great thing about Medicare Supplements is that they are very easy for consumers to use. I have never received a service call for a plan from any company we sell. They are very easy.

 

What insurance companies sell Medigap Plans in New Jersey? And how much do the Medigap plans in NJ cost?

Please reach out to me with the contact form on the right for up to date quotes.

2015 NJ Medigap Plans and Rates

*If older than 65 please contact me for a quote on your medicare supplement

1) NJ Medigap Female Non Tobacco Rates

2)NJ Medigap Female Tobacco Rates

3)NJ Medigap Male Non Tobacco Rates

4)NJ Medigap Male Tobacco Rates

Keep in mind that the tobacco rates are only applied if you are not in a guaranteed issued period. If you are 65 then this is likely the case.

 

 

Amerihealth NJ Medigap

Amerihealth Medigap plans were new for this year so I didn’t have a chance to work them into the intial post. Please reach out to me for a quote. They are in the top for best prices and are the only company I know of that offer a gym reimbursement and some other great benefits. Amerihealth is a subsidiary of Independence Blue Cross out of Pennsylvania and have been offering great group and individual plans for years.

These are rates from the past.

Please contact me or the insurance company for most up to date quote and the Medigap quote for your specific age. I will also assist in comparing each of the plans.

 

Medicare Supplement Frequently Asked Questions

  1. Do I need referrals?
    1. No. All Medigap plans are no referral
  2. Do I need to use certain doctors and do I need to make sure my doctor takes my Medigap plan?
    1. No. The only thing your doctor needs to know is that you have Original Medicare. That is your network. The supplement company, regardless of who it is, will pay the claim automatically if Medicare pays. If Medicare denies the claim, they will follow suit.
  3. How much do these plans go up every year?
    1. We usually see somewhere around 4% but Plan G has been 0% pretty often. There is a base rate that changes as you get older.
  4. Does Medicare and Medigap cover dental?
    1. No unfortunately not unless it is something medical in nature.
  5. When I do need to sign up?
    1. You can get onto a Medigap plan 3 months prior to your enrolling in Part B and 3 months after with no medical questions. You can change your plan anytime after that but you will need to go through medical underwriting.
  6. I’ve had the same plan for a while and its getting expensive, can I switch plans?
    1. Yes, just ask me for a quote and we will see what looks best. You will need to medically qualify and once you are accepted, you will cancel your old plan. Its a very easy process and most people can qualify.
  7. What if I apply for a plan with underwriting and I get denied?
    1. If you already have a plan, they can’t cancel that based on your current medical status. Other than that, nothing will happen.
  8. What if buy a plan in NJ and I move to another state?
    1. Depending on the company, they will transition you to your new state’s rates. Not all companies operate in every state though so you may keep the same rates.
  9. Do these plans cover prescriptions?
    1. Nope. Some prescriptions are covered under Part B, but you will need to purchase a Part D plan and I can help you with that.
  10. I’ve had Part B for a while but was covered under a group plan through my employer or my spouses, now what?
    1. You have 63 days to purchase a plan with no medical underwriting. The carriers restrict the plan though and you can get Plan F with no medical questions. If can move quickly, I would apply for Plan G with the best company and if you can’t qualify, then do Plan F.
  11. I thought Obamacare said an insurance company can’t deny coverage based on your health?
    1. You are correct, but these don’t follow those new affordable care act guidelines.
  12. I have Medicare Advantage now, but want a supplement?
    1. About two to three months before January 1, we will want to try and get you qualified for a supplement plan. If you are accepted, we will have the plan start January 1st. We will then enroll you in standalone Part D plan for January 1. That new Part D enrollment will terminate your Medicare Advantage plan.
  13. Can I pay for supplement through my social security?
    1. Unfortunately not. Most companies will require auto pay through your checking account if you pay monthly. If that is not ok, you can pay quarterly or we will put you with a company that allows paying monthly by check ( Amerihealth ideally or AARP)
  14. How long will it take to get my cards?
    1. Each company is a little different but for Aetna has been the fastest and will approve you in 24-48 hours with cards issued shortly thereafter. If you need to go through underwriting, it can take a few weeks.
  15. What else do I need?
    1. If you don’t have any money set aside for final expenses or wish to leave money to charity, let me know and we can quote a final expense life insurance policy or something that will fit your needs. There are plans that have no medical questions so its very easy to get started. You can get these plans any time but the sooner the better since the prices go up quite a bit as you get older and into your 70’s or early 80’s.
  16. Why would I go with you and not some other broker or direct to the company?
    1. I don’t think I’m better than anyone out there, but I promise to give you my best and will make sure you understand the process and exactly what you are buying. My goal is to answer everything upfront so you are completely comfortable with your decision.  I know when I am buying something new, I am uneasy about the unknown. When I work with you, I take that into consideration and map the whole thing out for you so that you can put your mind at ease. My prices will be identical to other brokers and the companies direct so I try to make your buying experience as easy as possible. I do face to face meetings, online enrollments, fax, webinars, regular mail or will work with you however it fits into your schedule.

 

Medicare Supplement Resources

Medicare Supplement Guide 2015

 

 

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

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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.

Medicare Supplement Plan G

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Cheapest Medicare Supplement Plan G  in NJ

Medicare Plan G is my number one choice for a Medigap Plan in NJ. We sell the most of the Medigap Plan F but that is because a lot of people feel most at ease with that plan.

 

Medigap chart plan f vs plan G

 

 

Medicare Supplement Plan G Benefits

As you can see in the chart above, Plan G is identical to Plan F except that you have to pay your $162 Part B deductible.  After that, everything is covered 100%.

 

Plan G Rates for Female Age 65 Absecon, NJ 08201

cheapest medigap plan g in nj for female age 65

 

 

 

 

 

 

 

Plan G Rates for Male Age 65 Absecon, NJ 08201

cheapest medigap plan g for male age 65 in south jersey

 

 

 

 

 

 

 

 

 

Like all of the supplement plans, Plan G is portable so you can take it with you throughout the country. Also since Plan G picks up excess charges, there is no worry about your physician accepting Medicare assignment. In addition, Plan G also has some limited Foreign Travel Emergency Benefits.

 

Medicare Supplement Plan G vs Plan F

Many people buy Plan F thinking it is the best option. In many ways it is but Plan G is usually the best buy when comparing the two. As long as the annual premium for Plan G is at least $140 less than the cheapest Plan F, I would buy G every time.

Another thing to consider is that there is a lot of adverse selection in Plan F. That plan tends to draw in people that have higher claims on average so the pool of individuals will tend to have higher rate increases over time. You can potentially sidestep some of that adverse selection by taking Plan G instead.

 

Medicare Supplement Plan G Drawbacks

Since Plan G is one of the best options, it is also the second most expensive. Before purchasing this plan you must be prepared to pay increasing prices as you get older. These plans are medically underwritten when you are out of your guaranteed issue period so there is the possibility that you won’t qualify for other coverage later if you find you can’t afford this plan.

If you are coming from a group plan and you are offered guaranteed issue rights, Part G isn’t part of that offer. You can only get Plan F. My suggestion to most people, is to apply for Plan G right away and go through medical underwriting. If you qualify, you are all set, but if you can’t then you still have time to purchase F before your guarantee period expires.

 Comparing Plan G to Plan N

When I run quotes for Medicare beneficiaries, I will usually also show Plan N to compare everything out. Plan N will be a bit cheaper than Plan G so is a good option but it does have some notable differences. Just like G, you need to pay your upfront Part B deductible, but then instead of your physician visits being covered 100%, you will pay a $20 copay. At the urgent care or emergency room, you will pay $50.

The last notable difference is that Plan N, you are not covered for excess charges. Excess charges don’t happen very often but if your provider doesn’t accept Medicare assignment, they are within their right to charge an additional 15% over the Medicare allowable amount. Again this doesn’t come up very often, but it does from time to time.

If you don’t mind the possibility of the excess charges or the copays here and there, I would also take a long look at Plan N. Either of the two plans will serve you well over time.

 

Insurance Companies selling Plan G in New Jersey

Here is my list as of 3/1/2016 from the New Jersey State Health Insurance Plan site. (NJ SHIP)

  • Aetna
  • American Progressive
  • Americo
  • Bankers Life
  • CSI
  • Colonial Penn
  • Combined
  • Genworth
  • Gerber Life
  • Horizon BCBS
  • IAC
  • Loyal American
  • Manhattan Life
  • Shenandoah Life
  • Sterling Life
  • United of Omaha

Of the list above, some of my favorites are Aetna and United of Omaha because they are very fast to issue policies, have some of the best rates, offer spousal discounts and are very easy to work with.

 

 

Request More Information On Medicare Supplement Plan G

If you are interested in Plan G, I would love the opportunity to earn your business. Please contact me for your:

Medicare Supplement Plan G Quote

Read more about NJ Medicare Supplement Plans