Health insurance in New Jersey
- New Jersey uses the federally run health insurance exchange so applicants currently enroll through HealthCare.gov.
- But the state plans to have a state-run exchange using HealthCare.gov by fall 2019, and a fully state-run exchange — with its own enrollment platform instead of HealthCare.gov — by fall 2020.
- Open enrollment for 2020 coverage in New Jersey will run from November 1 to December 15, 2019.
- Three insurers will offer 2020 coverage in New Jersey’s individual market.
- The average premium for 2019 decreased, but insurers have proposed fairly significant rate increases for 2020.
- 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
New Jersey uses the federally run exchange, which means residents enroll in exchange plans through HealthCare.gov.
But the state has plans to change that. By the fall of 2020 (for enrollment in 2021 coverage), New Jersey plans to be running its own exchange, with its own enrollment platform. At that point, residents will no longer use HealthCare.gov.
And the state plans to transition to a state-based exchange using the federal enrollment platform (SBE-FP) by the fall of 2019, which means New Jersey will be overseeing the exchange and consumer outreach during the last year that they use the HealthCare.gov enrollment platform.
Open enrollment for 2020 coverage will run from November 1 to December 15, 2019. Outside of that window, residents need to have a qualifying event in order to enroll.
Three carriers – AmeriHealth, Horizon BCBS and Oscar Health – offer plans in the New Jersey exchange in 2019, and all three will continue to do so in 2020.
Rates are still under review by state regulators, but New Jersey’s individual market insurers have proposed average rate increases for 2020 that range from about 6 percent to about 16 percent. This is considerably larger than the proposed rate increases in most states for 2020, but premiums decreased by more than 9 percent in New Jersey in 2019 (while increasing slightly nationwide) and average premiums in New Jersey in 2020 are about $100/month lower than the average across all states that use HealthCare.gov.
New Jersey enrollment in qualified health plans
During the open enrollment period for 2019 health coverage, 255,246 New Jersey residents enrolled in individual market health plans through the exchange. That was the second year in a row with a roughly 7 percent drop in enrollment, mirroring the national trend towards declining enrollment in states that use HealthCare.gov
Read more about the New Jersey health insurance marketplace.
Medicaid in New Jersey
New Jersey adopted the ACA’s Medicaid expansion and began utilizing federal funding to provide health insurance for the newly eligible population starting in 2014.
As a result, New Jersey’s Medicaid enrollment increased by 32 percent – more than 400,000 people – between the fall of 2013 and May 2019. Total Medicaid/CHIP enrollment in New Jersey as of mid 2019 stood at nearly 1.7 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 2017, that had fallen to 7.7 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 by 2016, but had grown slightly, to 8.7 percent, by 2017.
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 qualify based on age alone, while the remaining 13 percent are eligible due to disability.
Average per-enrollee Medicare spending in New Jersey stood at $10,398 in 2017, which was higher than the national average of $9,761. As of 2017, only six states had higher per-capita Medicare spending than New Jersey.
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, 22 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.
Health care reform legislation in New Jersey
New Jersey has enacted several important pieces of health care reform legislation recently, including:
- S.1878 (2018) — Directed 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. The state received federal approval for the program in 2018 and rolled it out in 2019, with average premiums decreasing by about 9 percent as a result.
- A.2039 (2018) — Protects patients from surprise balance bills if they receive treatment from an out-of-network provider at an in-network facility.
- A.3380 (2018) — Created an individual mandate in New Jersey, effective as of 2019. The penalty for non-compliance is based on the federal individual mandate penalty that applied until the end of 2018, and revenue collected from the penalty will be used to fund the state’s portion of the reinsurance program.
New Jersey’s legislative session continues throughout the year.
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.