Thanks to the introduction of the Affordable Care Act (ACA) Marketplace, you can now enroll in a health insurance plan online. Do you need coverage? Use our guide to health insurance in NJ to understand your plan options and get the plan that’s right for you.
Get Health Insurance in NJ
Tip: compare 2-3 companies
Best Health Insurance in NJ:
- Best Overall: AmeriHealth
- Best for First Time Shoppers: Horizon BCBS
- Most Affordable: Oscar Health
- Best for Dental & Vision: Humana
- Best for Orthodontic Care: Ameritas
- Best Health Insurance in NJ:
- What is Health Insurance?
- Average Cost of Health Insurance in New Jersey
- Types of Health Coverage
- What Does Health Insurance Cover?
- What Does Health Insurance Not Cover?
- Best Health Insurance Providers in NJ
- Best Dental and Vision Insurance Providers in NJ
- Protecting Your Health, Protecting Your Family
- Frequently Asked Questions
What is Health Insurance?
Health insurance is a type of coverage that pays for a percentage of your medical care costs. If you don’t have health insurance, you can be liable for tens of thousands of dollars in medical bills if you get sick or are involved in an accident. The right health insurance plan protects both you and your family from medical bankruptcy by ensuring you only pay a set dollar amount for care.
Every month, you’ll pay your health insurance company a premium that keeps your coverage current. You’ll also pay a set dollar amount out-of-pocket toward your own medical care costs — this is your plan’s “deductible.” Once you meet your deductible, you only need to pay a set percentage of your medical bills called a “coinsurance percentage.” Your plan will also include an “out-of-pocket maximum” that limits the total amount of money you can spend per year on healthcare.
Health insurance plans can cost hundreds of dollars per month — are they really worth the cost? It’s always a good idea to maintain some type of coverage. Here are just a few of the benefits of having health insurance:
- Insurance helps you pay your medical bills. If you don’t have health insurance, you must pay for 100% of your medical care costs. This can mean spending upwards of $4,000 per day you spend in the hospital and upwards of $170,000 for a major, life-saving surgery.
- An illness can strike at any time. You shouldn’t wait for a new job or upcoming marriage to get coverage. An illness or accident can hospitalize you at any time — and you need to be protected.
- You might be breaking the law. As a resident of New Jersey, you’re required to have some form of long-term health insurance unless you qualify for an exemption.
Most people get their health insurance through their employer or through a government-sponsored program like Medicare. If you don’t qualify for either of these, you can buy an independent plan from the ACA Marketplace by visiting Healthcare.gov. After creating an account on Healthcare.gov, you can shop for specific plan choices and browse plans by deductibles, premiums and covered drugs.
Average Cost of Health Insurance in New Jersey
The average resident of New Jersey spends about $500 per month on their individual health insurance plan. The specific amount you’ll pay for your coverage will depend on where you live, your plan provider, how many people are on your plan, your age and whether you use tobacco.
If your total household income is less than $50,000, you may qualify for a subsidy through the Marketplace. Enter your financial information on your Healthcare.gov account to learn more about subsidies you qualify for.
Types of Health Coverage
When you start shopping for a health insurance plan, you’ll see a myriad of plan types and acronyms. You might even see multiple types of plans available from a single insurance company. The biggest difference among plan types is the size of the network of doctors and specialists who accept your insurance. Let’s take a look at a few of the most common types of health insurance plans you’ll see on the ACA Marketplace.
- Health maintenance organization (HMO) plans: HMO plans have a set network of doctors and specialists contracted to provide discounted services to insurance holders. If you have an HMO plan, you must see a doctor in your network — otherwise, you cannot use your benefits. You also typically need to get a referral from your primary care provider before you can see a specialist. For most people, an HMO plan is the most affordable health insurance option.
- Preferred provider organization (PPO) plans: PPO plans aren’t as restrictive as HMOs. With a PPO, you can see any doctor or specialist you like without worrying about whether they’re in your network. You can also see a specialist without getting a referral from your doctor. PPOs are more expensive than HMOs, but they give you more freedom when using your benefits.
- Point of service (POS) plans: With a POS plan, you can see any doctor or specialist you want — like a PPO. However, you’ll save money if you choose to see an in-network care provider. You also need to get a referral before seeing a specialist. A POS plan might be right for you if you want to balance the cost and plan benefits between a PPO and an HMO.
What Does Health Insurance Cover?
After you create your Marketplace profile, you’ll be able to browse insurance plans available in your area. Every plan you see on the Marketplace is compliant with the regulations set by the ACA. This means that each plan must cover all of the ACA’s “essential benefits,” including these:
- Ambulatory patient services: This includes the care that you receive without going to the hospital.
- Hospitalization: This includes both overnight stays and surgeries.
- Emergency services: Your insurance must cover emergency services at both in-network and out-of-network hospitals. The ACA prohibits insurance companies from requiring you to visit a specific hospital or contact them in a true emergency.
- Prescription drugs: Insurance companies need to cover all major classes of prescription drugs. The ACA doesn’t compel insurance providers to cover every brand-name and generic drug. If you’re already taking a specific prescription, you can shop for ACA plans that include coverage for it using the Marketplace’s prescription search tools.
- Rehabilitative devices and treatments: This includes mobility devices and treatments intended to help you regain mobility after an illness or accident.
- Pregnancy, maternity and newborn care: Your insurance provider must offer coverage for all treatments and services you need throughout your pregnancy. It’s against the law for an insurance company to drop you from coverage or increase your premium because you’re now pregnant.
- Preventive care and screenings: This includes both routine tests (like STD tests and lipid panels) as well as regular preventive care (like vaccinations and annual physicals).
- Laboratory tests: This includes specialized diagnostic tests.
- Mental health and substance abuse treatments: This includes both inpatient and outpatient treatment for mental illness and substance abuse disorders.
- Pediatric services: Your insurance provider must offer all essential benefits to any children enrolled in your plan. Your plan also needs to include coverage for pediatric vision and dental benefits.
- Female birth control: If you’re a woman, your insurance provider must offer coverage for birth control. This requirement extends to hormonal methods (like birth control pills), implanted devices (like the IUD), barrier methods (like the sponge) and emergency contraceptives (like Plan B).
What Does Health Insurance Not Cover?
No matter which plan tier you choose and who services your insurance, your plan won’t cover everything. Let’s look at a few of the most commonly-excluded treatments and services.
- Male birth control: The ACA only requires insurance companies to provide coverage for male methods of birth control. This means that most insurers don’t cover male contraceptives like condoms and vasectomies.
- Adult vision and dental services: Your insurance needs to include coverage for vision and dental services for children on your plan. There’s no federal mandate that requires insurance providers to extend these services to adults. You can, however, purchase a separate vision and dental plan to supplement your coverage.
- Travel vaccinations: Health insurance only covers the routine set of recommended vaccinations set by the CDC. If you need a special vaccination for travel abroad (like an immunization for Yellow Fever or typhoid) you’ll need to pay for it out-of-pocket.
- Cosmetic surgery: No form of purely elective surgery is covered by health insurance.
- Bariatric surgery: There is no federal mandate that requires health insurance companies to cover bariatric surgery — even when deemed medically necessary. Insurance providers may elect to voluntarily provide this benefit on a plan-by-plan basis.
Best Health Insurance Providers in NJ
Now that you understand how to get health insurance and what insurance covers, it’s time to get covered. Let’s take a look at some of the best health insurance providers offering plans in the Garden State.
AmeriHealth is one of the top health insurance providers in New Jersey, offering both individual and family plans on the ACA Marketplace. All of its plans include each of the ACA’s essential benefits, and many higher-tier options also include discounts on dental plans as well.
You can manage your claims and benefits through AmeriHealth’s website or through its convenient mobile app. You can choose your network of doctors to balance the personalized care you want and keep your premium costs low.
2. Horizon Blue Cross Blue Shield
Horizon Blue Cross Blue Shield is New Jersey’s most popular choice for independent health insurance plans. Horizon now offers paperless online account management for all plan holders — giving you easier and safer access to your sensitive medical data.
Its comprehensive FAQ page is also packed with information on finding doctors in your network and using your benefits, which can be particularly useful for first time shoppers. Finally, Horizon offers a wide range of plan types and tiers suitable for nearly any budget.
3. Oscar Health
If you’re looking for plans with lower monthly premiums, consider Oscar Health when you compare coverage options. You can get an ACA-compliant plan for around $300 per month, and deductibles begin at $2,300 for more expensive options.
Most Oscar plans have low copays — you’ll pay $25 for a doctor’s visit and $25 for prescription drugs on most tiers. Oscar’s plans even include 24/7 telehealth conferences with in-network doctors — get a refill for a prescription or expert medical advice without making a trip to the doctor.
Best Dental and Vision Insurance Providers in NJ
Now that you’ve got your health insurance, complete your coverage with one of our favorite dental and vision plan providers.
Looking for a way to add dental and vision insurance to your plan without breaking the bank? Be sure to consider Humana when you compare insurance providers.
Humana offers comprehensive dental insurance plans from $23 in many parts of New Jersey, while vision insurance starts at just $15. Its plans even include affordable PPO coverage, meaning that you can use your benefits without worrying about finding an in-network dentist.
If you’re looking to add more comprehensive dental and vision coverage, consider a package plan from Ameritas. Ameritas’s dental insurance options start at $50 per month but offer more inclusive coverage — for example, most of its plans include 100% coverage for preventive care and pediatric orthodontic benefits.
Ameritas’s vision plans begin at just $11 per month and include low $25 copays for eye exams. Like Humana, you can quickly add both dental and vision coverage to your household coverage in as little as 15 minutes through Ameritas’s website.
Protecting Your Health, Protecting Your Family
If you’re living without health insurance, you might be gambling with your financial future. But getting the insurance you need to protect yourself and your family doesn’t need to be difficult. Start by paying a visit to Healthcare.gov and creating a profile. Enter a little personal information, fill out a few details about your household income and view your plan choices in as little as 15 minutes. Don’t wait — start researching your health insurance plan choices today.