Individual Health Insurance

Video Review of Amerihealth NJ Individual Health

September 11, 2014 By Mike

My review of the Amerihealth NJ Individual health insurance plans offered in New Jersey both on and off the healthcare exchange.

In this review I go over the three major reasons why I think Amerihealth NJ is a good choice for your individual health insurance.

Networks – they have one of the strongest networks of any of the health insurers in NJ and also provide access to many counties in Pennsylvania. They also give access to Nationwide coverage through their Multiplan partnership.
Plan Selection – they have 32 different plan offerings including HMO, EPO and POS plans. They also have a few HSA plan designs if you want to take advantage of low premiums and health savings account options.
Customer Service: Both as a broker and a consumer, I have found them to be very responsive and always getting things done when needed.

Review of Amerihealth NJ Individual Health Plans

Read more About Individual Health Insurance Here

High Deductible Health Plan Pros and Cons

March 5, 2012 By Mike Sheeran

Insurance companies in NJ have been raising their premium rates tremendously over the las few years, so many small business and employees are considering the switch to a high deductible health plan. It is important to evaluate all of the different options and to weigh the pros and cons of having a high deductible health plan so you can make the best choice for your family.

Before I get started into the pros and cons of having a high deductible health plan, lets make sure everyone is talking about the same thing. In this case, a high deductible plan, HDHP for short is a plan that has a higher deductible than most other plans and also has a out of pocket dollar maximum that a participant may have to pay throughout the year. So one example may be a plan with a $2500 single deductible and a $5,000 maximum out of pocket. These plans are usually HSA Qualified but that is not necessary for the purpose of this post.

High Deductible Health Plan Pros and Cons

High Deductible Health Plan Pros

Significantly lower health insurance premiums. In some cases, companies and individuals can slash their premiums by as much as 50% by changing to a high deductible health plan.
Self funded employers will see much lower claims usage when moving from a rich plan design to a higher deductible option. Lower claims equals lower renewal and more savings.
Employees also benefit with lower renewal rates because the price increases won’t be passed to them in the form of higher payroll deductions.
If the high deductible health plan is HSA Qualified, there are significant tax advantages. Also see ( HSA Rules for 2012)
For employees leaving the company, another pro of a high deductible plan will be lower COBRA premiums. Don’t forget that when you leave, you now are paying 102% of the full monthly insurance premium.

High Deductible Health Plan Cons

High Deductible in the beginning of the year. This is obvious, but worth mentioning. If you have any scheduled visits shortly after enrolling in new plan, you must be prepared to pay much larger fee for your service.
High deductible at the end of the calendar year. Most plans run calendar year so if you start the high deductible plan in November, the deductible will reset in January. You now have the potentional to pay the full deductible in November and December only to have it reset in a January.
More paperwork. Since you are now paying instead of the insurance company, expect to be getting a lot of different bills. Luckily the larger claims aren’t that frequent, so your paperwork should be fairly limited.
Will you avoid care? Even when the premium savings are there, some people will outright avoid proper medical care for fear of the potential bill. I can certainly understand this but you should focus on the total maximum out of pocket and consider the worst case scenario. My personal plan had a $5,000 maximum out of pocket. I knew that under the worst case scenario, I would be paying about $400 per month if I manage to max the plan out. Not too bad if I had a $1,000,000 claim.

Now that we reviewed some of the pros and cons of a high deductible health plan, lets look at how to evaluate options.

How to evaluate different high deductible health plan options

Step 1 – get the monthly premium for the different plan options and convert them to annual

Step 2 – add the annual maximum out of pocket for each of the plans to the annual premiums

Step 3 – evaluate

Example:

Plan 1 Annual Premium is $5,000 with a $5,000 maximum out of pocket.

Plan 2 Annual Premium is $9,000 with a $3,000 maximum out of pocket

Plan 3 Annual premium is $13,000 with everything covered 100%

In this example you have the potential to pay up to $10,000 in plan 1, up to $12,000 in plan 2 or a guaranteed $13,000 in Plan 3. So despite having a higher deductible, plan 1 would be the best choice in my opinion. The other benefit is that if you don’t use the plan at all, you have the potential to save $8,000 in premium compared to plan 3.

If you have any questions on evaluating the pros and cons of a high deductible health plan, please contact Mike Sheeran for more information.

Top Eight Resources for Uninsured New Jersey Residents to Get Health Insurance

July 10, 2011 By Mike Sheeran

I haven’t seen the latest numbers but previously there were over 1,000,000 New Jersey residents without health insurance coverage. While health insurance in New Jersey certainly isn’t cheap, there are many options for people to obtain quality insurance if they are willing to look and explore all their options. Some plans can be free or very inexpensive depending on your income level.

Before I provide the list, there are few things to keep in mind:

All New Jersey coverage is guaranteed issue. – there may or not be a pre-existing conditions clause though. There is a possibility that a carrier will not pay claims for any pre-existing condition for up to the first year. Please refer to your specific program for details.
Smokers and non-smokers pay the same rates.
New Jersey plans can only base your price on your age, your sex and your location. North Jersey will pay higher rates than Southern. Men pay less than women and older individuals will pay more than younger folks.

That being said, here is the list.

Top Eight Resources for Uninsured New Jersey Residents to Get Health Insurance

Employer based coverage- If you are working at least 25 hours at your current job, ask HR or your boss if coverage is available. Employers must pay 10% of the premium at a minimum so these prices may be less than other plans.
COBRA and New Jersey Continuation – if you had previous employer based coverage through a small or large business, you may still be eligible to enroll in New Jersey Continuation coverage or COBRA.
Dependent to 31 Coverage– http://www.state.nj.us/dobi/division_consumers/du31.html -DU31, P.L. 2005, c. 375, permits young adults to continue coverage or become covered under a parent’s group health plan as an over-age dependent until the young adult’s 31st birthday.A young adult may use the DU31 election right to:continue coverage under a parent’s group health benefits plan, when the young adult is “aging-out” of that parent’s coverage; orbecome covered under a parent’s group health benefits plan, so long as the young adult has had coverage at some time in the past.
New Jersey Family Care http://www.njfamilycare.org/ – NJ FamilyCare is a federal and state funded health insurance program created to help New Jersey’s uninsured children and certain low-income parents and guardians to have affordable health coverage. It is not a welfare program. NJ FamilyCare is for families who do not have available or affordable employer insurance, and cannot afford to pay the high cost of private health insurance.
Medicaid http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid provides health insurance to parents/caretakers and dependant children, pregnant women, and people who are aged, blind or disabled. These programs pay for hospital services, doctor visits, prescriptions, nursing home care and other healthcare needs, depending on what program a person is eligible for.
New Jersey Individual Health Insurance Program http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcmain.htm The Individual Health coverage program was created to ensure that people without access to employer or government sponsored health care programs could purchase health coverage for themselves and their families from a variety of private carriers. Individuals, regardless of their age or health status, are guaranteed renewable coverage under standard individual health benefits plans designed by the individual health coverage program board as well as under the “Basic and Essential” plans (B&E) sold by carriers.
New Jersey Protect/NJ Protect – http://www.state.nj.us/dobi/division_insurance/njprotect/index.htmNJ Protect is a new health insurance option for uninsured New Jerseyans with pre-existing medical conditions. Coverage through NJ Protect will generally cost less than comparable individual health insurance and offer superior benefits. Because the program is federally subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholders. NJ protect can be purchased through Horizon Blue Cross Blue Shield NJ or Amerihealth.
NJ Health Link – Services for uninsured or under-insured people. This site has an expansive list of other state/government subsidized programs and other options for obtaining health insurance or health care.

Final notes: Many of these programs are handled directly through the state or insurance carrier. If you need assistance with options 1, 2, 3 or 6 I can help you directly. Please contact me for any details or if you have other resources you think may be a good addition.

If you would like a quote on individual coverage, please contact me here.