New Jersey Health Insurance Rates – Compare Private And Senior Plans

Instantly view health insurance quotes for all NJ companies. Free online New Jersey quotes help you find the plans that match your budget and specific medical condition needs.  Easily compare prices, benefits, and policies in your area, and quickly and easily enroll for coverage. AmeriHealth New Jersey, Horizon Blue Cross Blue Shield, Oxford Health, and Oscar offer either off or on-Exchange under-65 coverage. Senior Medicare Supplement, Advantage, and Part D prescription drug plans are available to Medicare-eligible applicants.

In 2021, with CMS approval, the state will operate its own Exchange, and the enrollment process will change. The number of participating carriers should not be impacted. When approved, the state will retain more control over the enrollment process and platform, regulation, and the extension of Open Enrollment deadlines. The current average price increase for the three participating carriers are 11% (AmeriHealth), 6% (Horizon), and 16% (Oscar).

Individual New Jersey Health Insurance Plans (Under Age-65)

 

Catastrophic Tier

AmeriHealth IHC Local Value Simple Saver --  $30 pcp copay for first three office visits. $8,150 deductible with 0% coinsurance.

Horizon BCBSNJ Advantage EPO Essentials --  $0 pcp copay for first three office visits. $5 copay applies to Horizon CareOnline. $8,150 deductible with 0% coinsurance.

Oscar Simple Secure --  $30 pcp copay for first three office visits. $8,150 deductible with 0% coinsurance.

 

Bronze Tier

AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $25/$50 -- HSA-eligible  plan with $3,450 deductible and 50% coinsurance. $25 and $50 office visit copays after deductible has been met.

AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75 -- HSA-eligible  plan with $3,450 deductible and 50% coinsurance. $50 and $75 office visit copays after deductible has been met.

Oscar Classic Bronze -- $50 and $75 office visit copays subject to deductible. $3,000 deductible with 50% coinsurance. $75 copay for blood work. Generic drug copay is $25 ($62.50 mail order).

Horizon BCBSNJ Omnia Bronze -- $3,000 deductible and 50% coinsurance. $50 and $75 office visit copays ($15 Horizon CareOnline). $75 urgent Care copay. Generic drug copay is $25 ($50 mail order).

Horizon BCBSNJ Advantage EPO Bronze -- $30 pcp office visit copay ($15 Horizon CareOnline). $25 Generic drug copay ($50 mail order). $3,000 deductible with 50% coinsurance.

 

Silver Tier

AmeriHealth IHC Silver EPO AmeriHealth Advantage $25/$50 -- $25 and $50 office visit copays. $2,500 deductible and 20% coinsurance.  Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order).

AmeriHealth IHC Silver EPO HSA AmeriHealth Hospital Advantage $50/$75 -- $50 and $75 office visit copays. $2,000 deductible and 20% coinsurance.  Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order).

AmeriHealth IHC Silver HMO Local Value $50/$75 -- $50 and $75 office visit copays. $2,500 deductible and 50% coinsurance.  Generic, preferred and non-preferred drug copays are $15, 50%, and 50% ($30,  50%, and 50% mail order).

AmeriHealth IHC Silver EPO HSA Local Value $50/$75 -- $50 and $75 office visit copays. $2,000 deductible and 30% and 50% coinsurance. Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order).

AmeriHealth IHC Silver HMO Regional Preferred $50/$75 -- $50 and $75 office visit copays. $2,500 deductible and 50% coinsurance. Generic, preferred and non-preferred drug copays are $15, 50%, and 50% ($30, 50%, and 50% mail order).

AmeriHealth IHC Silver EPO Regional Preferred $50/$75 -- $50 and $75 office visit copays. $2,500 deductible and 50% coinsurance. Generic, preferred and non-preferred drug copays are 50% (50% mail order).

Oscar Saver Silver --  Office visits subject to deductible and coinsurance. $2,500 deductible with 40% coinsurance.

Oscar Classic Silver --  $50 and $75 office visit copays. $2,500 deductible and 50% coinsurance.  Generic, preferred and non-preferred drug copays are $25, 50%, and 50% ($20,  50%, and 50% mail order).

Horizon BCBSNJ OMNIA Silver HSA --  HSA-eligible  plan with $1,800 deductible and 30% coinsurance. $15 and $30 office visit copays after deductible has been met.

Horizon BCBSNJ OMNIA Silver  --  $30 and $50 office visit copays. $75 Urgent Care copay. $1,550 deductible and 50% coinsurance.  Generic, preferred and non-preferred drug copays are $15, 50%, and 50% ($30, 50%, and 50% mail order).

Horizon BCBSNJ OMNIA Advantage EPO Silver  --  $30 and $50 office visit copays. $2,500 deductible and 50% coinsurance.  Generic, preferred and non-preferred drug copays are $15, 50%, and 50% ($30, 50%, and 50% mail order).

Horizon BCBSNJ OMNIA Silver Value -- $30 pcp office visit copas. $2,250 deductible and 40% coinsurance. All drugs subject to coinsurance and deductible.

Oxford Health  Silver Copay Select 80 -- Off-Exchange plan. $2,250 deductible with 20% coinsurance. $50 and $75 office visit copays. $25 and $50 generic and preferred drug copays.

 

Gold Tier

Oscar Classic Gold Option 2 --  $10 and $50 office visit copays. $1,500 deductible and 20% coinsurance.  Generic drug copay s $10 ($25 mail order).

Oscar Classic Gold Option 1 --  $50 and $75 office visit copays. $2,400 deductible and 50% coinsurance.  Generic, preferred brand, and non-preferred brand drug copays are $24, $50, and $75 ($62,50, $125, and $187.50 mail order).

Horizon BCBSNJ OMNIA Gold  --  $10 and $25 office visit copays. $1,000 deductible.  Generic, preferred and non-preferred drug copays are $10, 40%, and 50% ($20, 40%, and 50% mail order).

AmeriHealth IHC Gold HMO Regional Preferred $15/$30 -- $15 and $30 office visit copays. $2,000 deductible and 40% coinsurance.  Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20,  50%, and 50% mail order).

AmeriHealth IHC Gold EPO Regional Preferred $30/$50/20% -- $30 and $50 office visit copays. $1,000 deductible and 50% coinsurance.  Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order).

 

New Jersey Health Insurance Rates

 

Sample Under Age-65 Monthly Rates (Approved by the NJ Department of Insurance)

35-Year-Old Residing In Bergen County ($30,000 Household Income)

$132 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75

$169 -- Horizon BCBSNJ Omnia Bronze

$170 -- Oscar Classic Bronze

$191 -- AmeriHealth IHC Silver EPO HSA AmeriHealth Hospital Advantage $30/$60 -- EPO

$199 -- Horizon OMNIA Silver Value

 

45-Year-Old Residing In Monmouth County ($40,000 Household Income)

$234 -- AmeriHealth IHC Bronze EPO AmeriHealth Advantage $25/$50

$257 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75

$300 -- Horizon BCBSNJ Omnia Bronze

$301 -- Oscar Classic Bronze

$315 -- AmeriHealth IHC Silver EPO AmeriHealth  Advantage $25/$50

 

55-Year-Old Residing In Middlesex County ($45,000 Household Income)

$261 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $25/$50

$319 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75

$327 -- Horizon BCBSNJ Omnia Bronze

$328 -- Oscar Classic Bronze

$349 -- AmeriHealth IHC Silver EPO AmeriHealth  Advantage $25/$50

 

50-Year-Old Married Couple (2 Persons) Residing In Essex County ($60,000 Household Income)

$261 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $25/$50

$319 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75

$425 -- Horizon BCBSNJ Omnia Bronze

$428 -- Oscar Classic Bronze

$490 -- AmeriHealth IHC Silver EPO AmeriHealth Advantage $25/$50

 

55-Year-Old Married Couple With Two Children (4 Persons) Residing In Hudson County ($92,000 Household Income)

$367 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $25/$50

$465 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75

$643 -- Horizon BCBSNJ Omnia Bronze

$647 -- Oscar Classic Bronze

$752 -- AmeriHealth IHC Silver EPO HSA AmeriHealth Hospital Advantage $50/$75

 

New Jersey 2020 Health Insurance Base Rates (Monthly)

 

Catastrophic Tier
 

$212.71 -- Oscar Simple Secure
$246.94 -- Horizon Advantage EPO Essentials
$255.58 -- AmeriHealth IHC Local value Simple Saver
 

Bronze Tier
 

$240.18 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $25/$50
$256.42 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $50/$75
$286.22 -- Horizon OMNIA Bronze
$286.63 -- Oscar Classic Bronze
362.92 -- Horizon Advantage EPO Bronze
$732.65 -- Oxford Health bronze Copay Select 50
 

Silver Tier
 

$267.30 -- AmeriHealth IHC Select Silver EPO AmeriHealth Advantage $25/$50
$272.26 -- AmeriHealth IHC Select Silver EPO HSA AmeriHealth Hospital Advantage $50/$75
$284.10 -- AmeriHealth IHC Select Silver HMO Local value $50/$75
$296.22 -- AmeriHealth IHC Silver EPO AmeriHealth Advantage $25/$50
$304.44 -- AmeriHealth IHC Silver EPO HSA AmeriHealth Hospital Advantage $50/$75
$311.05 -- Horizon OMNIA Silver Value
$314.26 -- AmeriHealth IHC Silver HMO Local Value $50/$75
$317.49 -- Oscar Classic Silver Off-Ex Only
$328.87 -- Oscar Saver Silver
$345.84 -- Horizon OMNIA Silver HSA
$349.23 -- Oscar Classic Silver
$367.97 -- Horizon OMNIA Silver
$378.95 -- AmeriHealth IHC Silver EPO HSA Local Value $50/$75
$448.29 -- Horizon Advantage EPO Silver
$510.73 -- AmeriHealth IHC Silver HMO Regional Preferred $50/$75.
$649.93 -- AmeriHealth IHC Silver EPO Regional Preferred $30/$70
$769.29 -- Oxford Health Silver Copay Select 70
$798.83 -- Oxford Health Silver Copay Select 80
 

Gold Tier
 

$464.27 -- Horizon HMO Gold
$505.99 -- Oscar Classic Gold Option 2
$524.24 -- Oscar Classic Gold Option 1
$551.14 -- Horizon OMNIA Gold
$620.57 -- AmeriHealth IHC Gold HMO Regional Preferred $15/$30
$675.64 -- AmeriHealth IHC EPO Gold Regional Preferred $30/$40/20% Coins

New Jersey Senior Medicare Health Insurance  Plans
 

Original Medicare Coverage (Parts A and B) is provided to many Seniors that have reached age 65. Generally, you must be a US citizen or a legal permanent resident. Inpatient hospital, home health and hospice care, and skilled nursing facility benefits are covered (Part A). Part A hospital benefits do not pay for a private room, unless medically necessary.

Part B benefits include office visits, lab tests and x-rays, outpatient physician services, and some preventative services, including counseling, screenings, and vaccines. Also included are ambulance services, durable medical equipment, mental health services, and chiropractic care (when spine manipulation is required).  Mental health insurance coverage is provided on all plans.

 

Sample NJ Medicare Supplement Monthly Preferred Rates (Prices Based On Female Age 65. Male Prices Are Often Higher)

Plan A

$101 -- AARP-UnitedHealthcare

$107 -- Amerihealth

$107 -- Humana

$115 -- Aetna

$120 -- Transamerica

$122 -- Philadelphia American

$130 -- Cigna

$131 -- Guarantee Trust Life

$132 -- Transamerica

$138 -- Union Security

$139 -- Mutual Of Omaha

$144 -- Thrivent

$148 -- Americo

$153 -- Greek Catholic Union

 

Plan B

$131 -- Aetna

$139 -- AARP-UnitedHealthcare

$173 -- Humana

$190 -- Colonial Penn

 

Plan C

$171 -- Liberty Banker's Life

$174 -- AARP-UnitedHealthcare

$174 -- Americo

$175 -- Aetna

$176 Renaissance Life

$177 -- Equitable National Life

$178 -- Shenandoah Life

$179 -- Thrivent

$183 -- Manhattan Life

$183 -- Massachusetts Mutual

$186 -- Loyal American

$186 -- Mutual Of Omaha

$205 -- Humana

$208 -- United American

$240 -- Horizon BCBS

 

Plan F

$159 -- Humana

$160 -- Manhattan Life

$163 -- Liberty Bankers Life

$165 -- Mutual Of Omaha

$165 -- AARP-UnitedHealthcare

$166 -- Aetna

$166 -- Americo

$167 -- Loyal American Life

$168 -- Equitable

$170 -- AmeriHealth

$170 -- Thrivent

$173 -- Cigna

$174 -- Americo

$174 -- Loyal Christian Benefit

 

Plan F (HD)

$49 -- Philadelphia American

$49 -- Colonial Penn

$49 -- Cigna

$51 -- United American

$54 -- Mutual Of Omaha

$62 -- Humana

$66 -- Aetna

 

Plan G

$130 -- Liberty Bankers Life

$131 -- Individual Assurance

$132 -- Equitable

$133 -- Loyal American Life

$133 -- Thrivent

$134 -- Shenandoah Life

$136 -- Mutual Of Omaha

$137 -- Americo

$137 -- Renaissance Life

$139 -- Massachusetts Mutual

$142 -- Aetna

$142 -- AARP-UnitedHealthcare

 

Plan N

$96 -- Equitable National Life

$97 -- Aetna

$104 -- Americo

$106 -- Loyal American

$106 -- Shenandoah Life

$108 -- Manhattan Life

$109 -- Banker's Fidelity

$109 -- Mutual Of Omaha

$110 -- Renaissance Life

$111 -- AARP-UnitedHealthcare

$113 -- Thrivent

$117 -- Colonial Penn

$118 -- AmeriHealth

$120 -- Massachusetts Mutual

$124 -- Horizon BCBS

 

Note: NJ Medicare Supplement plans are available to persons under age 50 with a qualifying disability (N.J.S.A. 17B:26A). A minimum of one carrier must offer coverage within six months of the applicant enrolling for Part B benefits. The rate must be identical to the premium paid by applicants that are age 65. A governing board oversees the program. Applicants between ages 50 and 64 can also apply for PLan C subject to similar requirements of applicants under age 50.

 

NJ Medicare Part D Plans

 

New Jersey  Prescription Drug Plans (Part D) 

Of the 28 available plans, 8 have monthly premiums less than $25, and 4 offer $0 premiums. The cheapest monthly rate is $13.20 and the most expensive monthly rate is $115.70. The average cost is $45.41. Eight plans reduced their 2020 rates while 15 plans increased their rate.

WellCare Value Script -- $15.70 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $0, $5, and $41.

WellCare Value Classic -- $34.90 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $0, $2, and $33.

WellCare Wellness Rx -- $13.30 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $0, $5, and $41.

WellCare Medicare Rx Select -- $24.00 monthly premium. $345 deductible with preferred generic, generic, and preferred brand drug copays of $0, $3, and $47.

WellCare Medicare Rx Saver -- $37.50 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $0, $2, and $28.

WellCare Medicare Rx Value Plus -- $74.60 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $1, $4, and $47.

Cigna-HealthSpring Rx Secure-Essential -- $22.20 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $0, $2, and 18%.

Cigna-HealthSpring Rx Secure-Extra -- $60.20 monthly premium. $100 deductible with preferred generic, generic, and preferred brand drug copays of $4, $10, and $42.

Cigna-HealthSpring Rx Secure -- $60.70 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $1, $2, and $30.

Express Scripts Medicare-Saver -- $24.10 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $1, $4, and 18%.

Express Scripts Medicare-Value -- $35.50 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $1, $3, and $25.

Express Scripts Medicare-Choice -- $93.30 monthly premium. $350 deductible with preferred generic, generic, and preferred brand drug copays of $2, $7, and $42.

Humana Walmart Rx Plan -- $24.40 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $1, $4, and 20%.

Humana Preferred Rx Plan -- $35.00 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $0, $1, and 25%.

Humana Enhanced -- $78.40 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $5, $10, and $47.

Mutual Of Omaha Rx Value-- $26.40 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $1, $4, and 15%.

Mutual Of Omaha Rx Plus-- $41.40 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $3, $6, and $32.

AARP MedicareRx Walgreens-- $28.00 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $0, $5, and $30.

AARP MedicareRx Saver Plus-- $35.50 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $1, $6, and $25.

AARP MedicareRx Preferred-- $74.80 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $5, $10, and $47.

Aetna Medicare Rx Saver-- $34.20 monthly premium. $295 deductible with preferred generic, generic, and preferred brand drug copays of $1, $2, and $30.

Aetna Medicare Rx Value Plus-- $58.70 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $1, $2, and $47.

SilverScript Choice -- $35.20 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $3, $14, and $43.

SilverScript Allure -- $80.00 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $1, $5, and 20%.

SilverScript Plus -- $85.20 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $1, $5, and $35.

Horizon Medicare Blue Rx Standard -- $49.90 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $1, $8, and $32.

Horizon Medicare Blue Rx Enhanced -- $102.00 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $1, $8, and $32.

EnvisionRxPlus -- $54.80 monthly premium. $415 deductible with preferred generic, generic, and preferred brand drug copays of $1, $8, and $32.

NJ Senior Medigap Plan Options

 

NJ Medicare Advantage Plans

Rates, benefits, and contract availability can vary, depending upon county of residence. Shown below are several available options with prescription drug  coverage included.

AARP MedicareComplete Plan 1 --  $0 monthly premium with $240 deductible. Pcp and specialist office visit copays are $20 and $45. Urgent Care and emergency care copays are $30-$40 and $90. Inpatient hospital copay is $395 for first four days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $3-$14. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $12, $45, and $95.

AARP MedicareComplete Plan 3 --  $36 monthly premium with $200 deductible. Pcp and specialist office visit copays are $5 and $20. Urgent Care and emergency care copays are $20-$40 and $90. Inpatient hospital copay is $250 for first five days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $5-$14. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $10, $47, and $95.

AARP MedicareComplete Plan 4 --  $81 monthly premium with $100 deductible. Pcp and specialist office visit copays are $0 and $20. Urgent Care and emergency care copays are $20-$40 and $90. Inpatient hospital copay is $195 for first five days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $5-$14. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $10, $47, and $95.

Aetna Medicare Elite Plan 1 --  $0 monthly premium with $0 deductible. Pcp and specialist office visit copays are $10 and $20. Urgent Care and emergency care copays are $10-$20 and $90. Inpatient hospital copay is $650. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$35. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $0, $10, $47, and $100.

Aetna Medicare Standard Plan --  $78 monthly premium with $195 deductible. Pcp and specialist office visit copays are $10 and $30. Urgent Care and emergency care copays are $10-$30 and $90. Inpatient hospital copay is $330 for five days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$45. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $5, $47, and $100.

Aetna Medicare Smart Choice Plan --  $0 monthly premium with $295 deductible. Pcp and specialist office visit copays are $30 and $50. Urgent Care and emergency care copays are $30-$50 and $90. Inpatient hospital copay is $515 for three days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$50. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $5, $47, and $100.

Aetna Medicare SNJ Prime Value Plan --  $0 monthly premium with $245 deductible. Pcp and specialist office visit copays are $20 and $45. Urgent Care and emergency care copays are $20-$45 and $90. Inpatient hospital copay is $395 for four days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$50. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $5, $47, and $100.

Aetna Medicare NNJ Prime Value Plan --  $0 monthly premium with $195 deductible. Pcp and specialist office visit copays are $5 and $25. Urgent Care and emergency care copays are $5-$25 and $90. Inpatient hospital copay is $295 for five days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$50. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $5, $47, and $100.

Aetna Medicare NJ Silver Plan --  $66 monthly premium with $245 deductible. Pcp and specialist office visit copays are $15 and $50. Urgent Care and emergency care copays are $15-$50 and $90. Inpatient hospital copay is $340 for five days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$50. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $5, $47, and $100.

Amerivantage Classic --  $0 monthly premium with $250 deductible. Pcp and specialist office visit copays are $10 and $35. Urgent Care and emergency care copays are $65 and $90. Inpatient hospital copay is $650. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$90. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $4, $10, $42, and $95.

Amerivantage Balance --  $37.20 monthly premium with $415 deductible. Pcp and specialist office visit copays are $10 and $40. Urgent Care and emergency care copays are $65 and $90. Inpatient hospital copay is $325 for first 5 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$100. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $0, $14, $47, and $95.

Clover Health Classic (HMO) --  $0 monthly premium with $150 deductible. Pcp and specialist office visit copays are $0 and $25. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $290 for first 6 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$150. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $0, $10, $37, and $85.

Clover Health Choice (PPO) --  $0 monthly premium with $150 deductible. Pcp and specialist office visit copays are $0 and $25. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $290 for first 6 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$150. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $0, $10, $37, and $85.

Clover Health Choice Value (PPO) --  $37.20 monthly premium with $415 deductible. Pcp and specialist office visit copays are $0 and $5. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $170 for first 6 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with 20% coinsurance. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $0, 22%, 22%, and $25.

Erickson Advantage Freedom --  $48.00 monthly premium with $0 deductible. Pcp and specialist office visit copays are $20 and $40. Urgent Care and emergency care copays are $30 and $75. Inpatient hospital copay is $200 for first 7 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with $0-$50 copays. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $5, $10, $45, and $85.

Horizon Medicare Blue Advantage --  $75 monthly premium with $0 deductible. Pcp and specialist office visit copays are $10 and $25. Urgent Care and emergency care copays are $20-$25 and $90. Inpatient hospital copay is $320 for first 5 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$25. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $1, $9, $40, and 35%.

Horizon Medicare Blue Choice w/Rx --  $198.70 monthly premium with $415 deductible. Pcp and specialist office visit copays are $10 and $40. Urgent Care and emergency care copays are $25-$40 and $90. Inpatient hospital copay is $225 for first 8 days and $113 for day 9. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$40. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $1, $9, $28, and $60.

Humana Value Plus --  $30.30 monthly premium with $365 deductible. Pcp and specialist office visit coinsurance is 20%. Urgent Care and emergency care copays are 20% and $90. Inpatient hospital copay is $1,860. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-20%. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $0, $14, $47, and $97.

HumanaChoice --  $29.00 monthly premium with $250 deductible. Pcp and specialist office visit copays are $0 and $20. Urgent Care and emergency care copays are $0-$25 and $90. Inpatient hospital copay is $275 for days 1-5. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$75. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $2, $8, $47, and $100.

Wellcare Value --  $0 monthly premium with $0 deductible. Pcp and specialist office visit copays are $5 and $30. Urgent Care and emergency care copays are $25 and $90. Inpatient hospital copay is $325 for first 5 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$50. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $1, $12, $47, and 48%.

Wellcare Rx --  $20.16 monthly premium with $415 deductible. Pcp and specialist office visit copays are $0 and $25. Urgent Care and emergency care copays are $25 and $90. Inpatient hospital copay is $330 for first 4 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$50. Tier 1, Tier 2, Tier 3, and Tier 4  30-day preferred pharmacy drug copays are $1, $12, $47, and 50%.

NJ Family Care Health Insurance

NJ FamilyCare

NJ FamilyCare is the publicly-funded (state and federal) health insurance organization for New Jersey.  Free or extremely affordable single and family plans are offered through  Medicaid and CHIP.  Comprehensive coverage is offered, including major medical, office visits, prescriptions, inpatient and outpatient hospitalization, vision and dental benefits, ER, mental health and substance abuse benefits, x-rays, and lab tests. Approximately 1.7 million person are currently enrolled.

Children under age 19 are eligible for coverage with Family Federal Poverty (FPL) Levels up to 355%. Parents with income up to 138% of FPL and at least one tax-dependent child are eligible. Pregnant women with income up to 205% of FPL are eligible. And adults with dependent children with incomes up to 138% of FPL are eligible.

Legal Permanent Resident status is required for adults that are immigrants. "Qualified" applicants include (but are not limited to) lawful permanent residents, refugees, a child of a member of the US military, and an immigrant that has been paroled for more than 12 months.

Participating companies are Aetna, Amerigroup (Anthem), Horizon BCBS, UnitedHealthcare, and WellCare. Applications for coverage can be mailed, or downloaded online. Enrollment and outreach centers also have applications that can be picked up or completed in-person.

The HBID (Health Benefits Identification Card)  is provided to members to use the fee-for-service benefits contained in the package of benefits.  An additional card is provided by the participating company (see above). Both cards must be presented at the time of service.

To be eligible for coverage, applicants must be uninsured for at least three months, although several approved exceptions are available. If you work outside of New Jersey, it is also possible that your family may be able to obtain a policy.

Plan First is administered by NJ FamilyCare. Family planning services are provided, although since benefits ae limited, other medical coverage should be acquired if possible. Covered benefits include condoms, pregnancy tests, family planning lab tests, counseling, birth control, and vasectomies for males that have reached age 21. Eligible applicants include persons not currently sterile or pregnant, legal US citizen or qualified immigrant, state resident, not currently eligible for NJ FamilyCare, and monthly income between $1,438 and $2,134 (one person).

 

Small Employer Health Insurance Benefits

 

A "Small Employer Health Benefits" (SEH) program was created more than 25 years ago to help small employers obtain quality group medical coverage regardless of health conditions or occupation of any member of the group. Also, policies can be annually renewed, regardless of the claims history of the group or any individual. Pre-existing condition exclusions have been waived along with small goup participation requirements and employer contribution requirements.

Workers, their children, and their spouses, can continue receiving plan benefits despite no longer being eligible, or offered COBRA benefits. Research materials and buyers guides are offered on the official website. Brochures and current rates are also available through the website or by phone. Participating carriers in the SEH program are AmeriHealth, Horizon, Oscar, and Oxford Health. Participating stand-alone dental carriers are AmeriHealth, Ameritas, Delta Dental, Guardian Life, Horizon, International Healthcare Services, MetLife, Reliance Standard Life, and Standard Insurance.

The following persons do not qualify as employees: Partners in a partnership, 2% shareholders in an S-Corp, independent contractors, sole proprietors, leased employees, and married couple when one spouse is an owner of the business. A "full-time" employee must be working 25 hours per week. If only one employee in the company, he/she must be working 30 hours per week. At least 75% of the full-time employees must be covered under the employee-offered plan, or one of the following: NJ FamilyCare, Medicare, Medicaid, TriCare, Spouse's group plan, another qualified group plan, or another qualified small group plan.

 

Federally Qualified Health Centers (FQHCs)

These Centers offer quality medical treatment regardless of the patient's income or ability to pay the bill. Prior coverage is not required (compliant or non-compliant), and both Medicare and standard insurance are accepted. If you do not have existing medical benefits, your cost of treatment is based upon your household income.

Services offered at each Center include lab services, dental treatment, preventative and primary care, pediatric services, mental and behavioral health, and HIV testing. Several NJ locations are listed below:

Newark: Jewish Renaissance Medical Centers (several locations), Newark Community Health Centers (several locations),  and Newark Department of Health and Community Wellness (several locations).

Jersey City --  Horizon Health Center (several locations) and Metropolitan Family Health Network (several locations).

Paterson -- Paterson Community Health Center (several locations).

Elizabeth -- Neighborhood Health Services Corp.

Trenton -- Henry J. Austin Health Center (several locations).

Somerset -- Zufall Health Center.

Monmouth -- Monmouth Family Health Center and Ocean Health Initiatives.

Gloucester -- CAMcare Health, Complete Care Health Network (several locations).

 

Catastrophic Illness In Children Relief Fund

This program provided financial help to the family of children that have no insurance coverage for serious medical conditions, and federal, state, and fundraising options are not available. Acute or chronic illnesses that are not fully covered by insurance or government programs, may be eligible.

Several categories of expenses that are generally covered include addiction, mental health services, physician care, pharmaceuticals, home health care, pediatric ambulatory care, medical transportation, inpatient and outpatient  specialized care, and experimental medical treatment.

 

Dental Coverage

SADPs (stand-alone dental plans) are offered by many carriers.  Pediatric benefits are required, and plans must be offered on the Marketplace. Participating carriers include AmeriHealth, Delta Dental, Dentegra, Dominion National, Guardian Life, HealthPlex, Horizon, and Renaissance Life.

Additional carriers that are approved to offer dental plans, but not SADPs, are Aetna,  American Family Life, Ameritas Life, Cigna, Golden Rule (UnitedHealthcare), Madison National Life, MetLife,  Mutual Of Omaha, Security Life, Time Insurance, and United Concordia Life.

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