New Jersey Health Insurance: 2021 Coverage Guide

Fran Majidi
August 27, 2020

New Jersey Affordable Healthcare Insurance

Folks in the Garden State will soon be buying health insurance. The good news is that there are several options for health insurance plans and different levels of coverage. However, everyone should compare rates carefully and understand the benefits they are entitled to before they buy a plan. If you’re an individual or you’re buying coverage for a family, you can get the coverage you need at the best prices by comparing your options with SmartFinancial. Most people can only enroll in a health plan during open enrollment, unless they are eligible for the Special Enrollment Period due to a qualifying event. Make sure to sign up when you can or else you may have to wait another year to get insured.

When Is Open Enrollment in New Jersey?

November 1, 2020 - December 15, 2020. Coverage begins January 2021.

How to Get Health Insurance in New Jersey

Buying health insurance can be confusing. There are different levels of coverage so it’s important to only compare apples to apples. You can choose the tier of coverage that is most economical based on the prior year’s healthcare needs and costs. You can estimate the following year’s costs and decide which level of protection will cost you the least. For instance, if you have a condition that requires multiple doctor visits in a month or year, you may consider a higher level of coverage (platinum or gold) for maximum savings. If you’re young and healthy and only want to safeguard yourself against the unexpected, you may consider a bronze tier health plan. If you see many providers during the course of the year, the cheapest plan may cost you more in out-of-pocket expenses.

After you figure out which level of health care suits your needs and budget, you should compare health insurance companies and health insurance quotes. After you submit the form from SmartFinancial, you’ll receive competing health insurance rates, and we’ll connect you with an agent in your area so you can buy the coverage or ask questions.

What Types of Health Insurance Are Available in New Jersey?

HMOs, EPOs, PPOs and POS health plans are the most common types of health insurance but there are other short-term insurance plans and catastrophic plans available in New Jersey too.

Does Health Insurance Cover Pre-existing Conditions?

Yes, the ACA made it illegal to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • If you lost a job, changed jobs to where insurance was not offered or even started your own business, you qualify to buy health insurance outside the open enrollment period.
  • If you turned 26 and can no longer be your parents’ health insurance plan, you can buy an individual health plan.
  • If you moved outside the coverage area and your insurance is not valid where you live, you can buy a new health plan.
  • If you extended your healthcare with Cobra and reached the deadline, you can enroll in a new health plan.
  • If you divorced a spouse and had been sharing a health plan, you may enroll in a new health plan.
  • If you recently got married, you may buy a new health insurance plan together or individually.
  • If you gave birth or adopted a child, you may buy a new health plan for that child.
  • If you shared a health insurance policy with a spouse or partner and they passed away, you can enroll in a new health plan.
  • If you shared a health plan with a spouse or partner and they lost coverage, you may be able to buy a new health plan together or as individuals.

Is Health Insurance Required in New Jersey?

Yes, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty.

How Much Is Health Insurance in New Jersey?

The average cost of health insurance in the state of New Jersey for a 40-year-old is about $379 a month. Health insurance becomes more expensive as you age. Tobacco use increases health insurance rates too.

How to Save on Health Insurance in New Jersey

Save on health insurance in New Jersey by comparing rates based on the tier system. Before choosing a plan, you’ll want to estimate your medical costs for 2021.

Medicare in New Jersey

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental, and prescription drug coverage.

How Many People Are on Medicare in New Jersey?

18% of the people living in New Jersey are on Medicare.

How Much Is Medicare in New Jersey?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income. .

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government-subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in New Jersey

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in New Jersey?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

New Jersey State Health System Ranking

  • New Jersey: Overall State Ranking: 20 of 51
  • New Jersey: Overall Performance: Worse than Average
  • New Jersey: Access & Affordability: 19
  • New Jersey: Prevention & Treatment: 22
  • New Jersey: Avoidable Hospital Use & Cost: 30
  • New Jersey: Healthy Lives: 12
  • New Jersey: Health Care Disparities: 21
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New Jersey Health Insurance Coverage

The people of New Jersey have different kinds of health insurance while some New Jersey residents are not insured at all. See the breakdown below:

  • Private coverage: 56%
  • Medicaid: 17%
  • Medicare: 18%
  • Uninsured: 9%

New Jersey Health Insurance Companies

  • Aetna
  • AmeriHealth HMO Inc
  • Amerihealth Insurance Company
  • Cigna Health and Life Insurance Company
  • Horizon Blue Cross Blue Shield of NJ
  • Horizon Healthcare of NJ
  • Oscar Garden State Insurance Corporation
  • Oxford Health Insurance (NJ) Inc.
  • UnitedHealthcare Insurance Company
  • QualCare, Inc.

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