Health insurance in New Jersey
- New Jersey uses the federally run health insurance exchange so applicants enroll through HealthCare.gov.
- Open enrollment in New Jersey continues through December 15, 2018.
- Three insurers are offering 2019 coverage in New Jersey’s individual market.
- The average premium for 2019 is decreasing.
- Almost 275,000 New Jersey residents enrolled in 2018 coverage through the exchange.
- New Jersey has accepted the ACA’s Medicaid expansion.
- Short-term health plans are not available for purchase in New Jersey.
- New Jersey’s CO-OP, Health Republic Insurance of New Jersey, stopped offering plans in 2017.
New Jersey’s health marketplace
Three carriers – AmeriHealth, Horizon BCBS and Oscar Health – offered plans in the New Jersey exchange last year and they are offering plans again for 2019. Health insurance premiums on average will decline by 9.3 percent in 2019, thanks to a state reinsurance program approved in August 2018.
New Jersey enrollment in qualified health plans
A Kaiser Family Foundation study released in the fall of 2013 found that about 628,000 New Jersey residents would be potential customers for the exchange, and that about 400,000 of them would be eligible to receive premium subsidies. So the state enrolled about a quarter of its eligible population in the first open enrollment period, leaving plenty of room for growth.
A total of 288,573 people enrolled in New Jersey exchange plans during the 2016 open enrollment period. Enrollment grew to 295,067 for 2017, but dropped down to 274,782 during the open enrollment period for 2018 coverage.
Read more about the New Jersey health insurance marketplace.
Medicaid in New Jersey
As a result, New Jersey’s Medicaid enrollment increased by 36 percent – nearly 460,000 people – between the fall of 2013 and November 2017. Total Medicaid/CHIP enrollment in New Jersey as of late 2017 stood at nearly 1.75 million people.
Read more about Medicaid expansion in New Jersey.
Short-term health insurance in New Jersey
Despite new federal short-term health insurance regulations that have rolled back restrictions on short-term plans, the plans are not for sale in New Jersey. A New Jersey statute that governs individual health insurance plans includes requirements that are not compatible with the short-term plans, so short-term coverage is essentially prohibited in the state – and short-term plans have not been sold in the state for 25 years.
And that’s not likely to change any time soon: the New Jersey Department of Banking and Insurance has submitted comments noting that New Jersey’s ban on short-term plans would continue, regardless of any changes at the federal level.
Read more about short-term health insurance in New Jersey.
How did Obamacare help New Jersey residents?
New Jersey opted to let the federal government run its health insurance exchange but expanded Medicaid in 2014. Has access to affordable health insurance improved for its residents under the Affordable Care Act?
In 2013, according to US Census data, 13.2 percent of New Jersey residents were uninsured. By 2016, that had fallen to 8 percent. Across all states, the uninsured rate started out higher than New Jersey – at 14.5 percent – and fell to an average of 8.6 percent.
There is no doubt that the reduction in the uninsured rate is due to the ACA, and to the state’s acceptance of federal funding to expand Medicaid.
New Jersey’s health insurance CO-OP
Health Republic Insurance of New Jersey was the trade name for Freelancer’s CO-OP of New Jersey, a Consumer Oriented and Operated Plan (CO-OP) established under the ACA. CO-OPs in 22 states received a total of $2 billion in grants from the federal government to establish their programs; Freelancer’s CO-OP of New Jersey received $109 million.
Most of the CO-OPs have since gone out of business; only four remain operational in 2018. New Jersey’s CO-OP was among the seven still in operation as of September 2016. But that month, the NJ Department of Banking and Securities placed Health Republic into rehabilitation and the CO-OP was no longer sell new policies. Existing Health Republic policies terminated at the end of 2016; as a result, nearly 35,000 individuals needed to find new health plans for 2017.
Initially, the hope was that state regulators would be able to stabilize the company enough for it to return to the marketplace in 2018, but that did not come to pass. On February 3, 2017, an order of liquidation for Health Republic was filed. All of the CO-OP’s assets were liquidated to repay creditors to the extent possible.
Medicare enrollment in the state of New Jersey
About 87 percent of New Jersey Medicare beneficiaries qualified based on age alone, while the remaining 13 percent were eligible due to disability.
Per-enrollee Medicare spending for New Jersey trends higher than the national average at $9,686 per year compared with $8,970. As of 2009, the state ranked 9th in the nation for overall Medicare spending.
Medicare Advantage plans offer New Jersey Medicare participants a way to gain more healthcare benefits; they are an alternative to Original Medicare. In New Jersey, 21 percent of Medicare enrollees select a Medicare Advantage plan; nationwide, an average of 33 percent of Medicare beneficiaries select Medicare Advantage plans.
Medicare Part D plans offer New Jersey Medicare recipients stand-alone prescription drug coverage. In 2017, Part D enrollees accounted for 59 percent of New Jersey’s total Medicare population, as opposed to 44 percent nationwide. This makes sense, given that a larger portion of New Jersey’s Medicare enrollees have Traditional Medicare (versus Medicare Advantage) than the US population, and stand-alone Medicare Part D plans are designed to supplement Traditional Medicare.
Bills under consideration in the state legislature in 2018
Lawmakers in New Jersey considered a variety of health care reform bills in 2018, including:
- S.564 — would prevent any health insurance policy from being sold in New Jersey unless it meets NJ statutes. This bill was introduced to prevent the proliferation of association health plans that could crop up as a result of Executive Order 13831, which President Trump signed in October 2017; short-term plans, which the EO calls for expanding, are already prohibited in New Jersey. But on the other end of the political spectrum, A.283 would allow out-of-state insurers to offer plans in New Jersey without having to comply with the full list of NJ regulations.
- S.1877 — would implement a state-based individual mandate in New Jersey, to replace the ACA’s individual mandate that will be eliminated at the end of 2018.
- S.1878 — would direct the state to propose a 1332 waiver in order to establish a reinsurance program to stabilize the individual market, using federal funding that would otherwise have been spent on higher premium subsidies.
- A.352 — would require that exchange insurers remain in the exchange if they wish to be contracted with the state to offer Medicaid managed care plans.
- A.469 — would allow sole proprietors to join a state-based small employer health benefits purchasing alliance, as opposed to only businesses with two or more employees.
- A.1343 / S.561 — would create a public health insurance option in New Jersey, which would compete with the private market options.
- A.2039 — would protect patients from surprise balance bills if they receive treatment from an out-of-network provider at an in-network facility.
- S.924 — if a primary care doctor leaves or is terminated from an insurer’s network, patients would be able to continue to receive in-network care from that doctor for up to 12 months.
- A.710 — out-of-network care for a catastrophically ill child would be covered as in-network (as long as referred by an in-network provider) under Medicaid, CHIP, and private plans.
- A.377 — would require hospitals to assist uninsured patients with the process of creating an exchange account on HealthCare.gov.
New Jersey’s legislative session continues throughout the year. Keep an eye on those bills.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.