Instantly view NJ health insurance quotes for all 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. Aetna, AmeriHealth New Jersey, Horizon Blue Cross Blue Shield, Oxford Health (Off-Exchange), Oscar, and Wellcare (Ambetter) 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.
Two years ago, with CMS approval, the state began operating its own State-Based Exchange (SBE), and the enrollment process changed. The number of participating carriers is not be impacted, and the state can retain more control over the enrollment process and platform, regulation, and the extension of Open Enrollment deadlines. "Get Covered New Jersey" is the official website that handles the enrollment. The OE period is from November 1 through January 31.
GetCoveredNJ provides enrollment assistance and allows consumers to compare prices, view available doctors and specialists, estimate medical costs, and easily calculate the amount of federal subsidy (if available). NJ Family Care may be offered to eligible persons. CHIP and Medicaid provide low-cost plan options. Income and size of household determines eligibility. NJ FamilyCare offers coverage throughout the entire year. Household and income information is required to determine eligibility.
A 2.5% tax on health insurance companies helps pay the cost of Marketplace plans for households that earn no more than four times the Federal Poverty Level (FPL). About $200 million of funds are expected to fund the Health Insurance Affordability Fund. The State Reinsurance fund will also receive funds. The FPL eligibility is $14,580 for a single person, $19,720 (2-person family), $24,860 (3-person family), $30,000 (4-person family), and $35,140 (5-person family).
Requested 2024 plan rate changes are listed below:
Aetna EPO-IVL -- 5.47% increase
Aetna EPO- OFF IVL -- 3.485 increase
AmeriHealth Individual HMO -- 4.28% increase
AmeriHealth Individual Insurance -- 3.79% increase
Horizon Healthcare Advantage EPO -- 7.24% increase
Horizon Healthcare Omnia -- 4.09% increase
Horizon Healthcare Catastrophic -- 7.58% increase
Oscar NJ 001 -- 6.74% decrease
Oxford NJ EPO -- 13.81% increase
Wellcare (Ambetter) -- 8.25% increase
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. $9,450 deductible with 0% coinsurance.
Horizon BCBSNJ Advantage EPO Essentials -- $0 pcp copay for first three office visits. $5 copay applies to Horizon CareOnline. Deductible applies to specialist visits. $9,450 deductible with 0% coinsurance.
Oscar Secure -- $0 pcp copay for first three office visits. $9,450 deductible with 0% coinsurance.
Bronze Tier
AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $25/$50 -- HSA-eligible plan with $6,000 deductible and 50% coinsurance. $25 and $50 office visit copays after deductible has been met. $8,000 maximum out-of-pocket expenses.
AmeriHealth IHC Bronze EPO HSA Local Value 50%/50% -- HSA-eligible plan with $6,000 deductible and 50% coinsurance. No office visit copays. $8,000 maximum out-of-pocket expenses.
AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75 -- HSA-eligible plan with $6,000 deductible and 50% coinsurance. $50 and $75 office visit copays after deductible has been met. $8,000 maximum out-of-pocket expenses.
AmeriHealth IHC Bronze EPO Local Value $50/$75 -- 3,000 deductible and 50% coinsurance. $50 and $75 office visit copays after deductible has been met. $25 and $50 (Mail order) generic drug copay. $9,450 maximum out-of-pocket expenses.
Oscar Bronze Classic -- $50 and $75 office visit copays subject to deductible. $3,000 deductible with 50% coinsurance. $75 copay for blood work. X-rays have a $75 copay but are subject to the deductible. Generic drug copay is $25 ($62.50 mail order). $9,100 maximum out-of-pocket expenses.
Horizon BCBSNJ Omnia Bronze -- $3,000 deductible and 50% coinsurance. $50 and $75 office visit copays ($15 Horizon CareOnline). $75 Urgent Care copay. No charge for diagnostic tests performed in office or independent labs. Generic drug copay is $25 ($50 mail order). $9,100 maximum out-of-pocket expenses.
Horizon BCBSNJ Advantage EPO Bronze -- $30 pcp office visit copay ($15 Horizon CareOnline including specialist visits). $25 Generic drug copay ($50 mail order). $3,000 deductible with 50% coinsurance. $9,100 maximum out-of-pocket expenses.
Ambetter Bronze 1005 -- $3,000 deductible and 50% coinsurance. $50 and $75 office visit copays. $75 Urgent Care copay. $20 copay for diagnostic tests. Generic drug copay is $25 ($50 mail order). $9,100 maximum out-of-pocket expenses.
Aetna Bronze -- $6,000 deductible and 50% coinsurance. $50 and $75 office visit copays. $75 Urgent Care copay. $20 copay for diagnostic tests. Generic drug copay is $25 ($50 mail order). $7,000 maximum out-of-pocket expenses.
Aetna Bronze $0 MinuteClinic -- $50 and $75 office visit copays subject to deductible. $3,000 deductible with 50% coinsurance. $25 copay for blood work and X-rays have a $75 copay but are subject to the deductible. Generic drug copay is $25. $8,850 maximum out-of-pocket expenses.
Silver Tier
AmeriHealth IHC Silver EPO AmeriHealth Advantage $25/$60 -- $25 and $60 office visit copays. $2,500 deductible and 20% coinsurance. Urgent Care copay is 20%. Generic, preferred and non-preferred drug copays are $25, 50%, and 50% ($50, 50%, and 50% mail order). $9,100 Maximum out-of-pocket expenses.
AmeriHealth IHC Silver EPO HSA AmeriHealth Hospital Advantage $50/$75 -- $50 and $75 office visit copays. Urgent Care copay is $85. $2,000 deductible and 20% coinsurance. Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order). $7,450 maximum out-of-pocket expenses.
AmeriHealth IHC Silver EPO Hospital Advantage $50/$75 -- $50 and $75 office visit copays. Urgent Care copay is $85. $2,500 deductible and 50% coinsurance. Generic, preferred and non-preferred drug copays are $20, 50%, and 50% ($40, 50%, and 50% mail order). $9,1000 maximum out-of-pocket expenses.
AmeriHealth IHC Silver EPO Advantage $45/40% -- $45 pcp office visit copay. $2,100 deductible and 40% coinsurance. Generic, preferred and non-preferred drug copays are $20, 50%, and 50% ($40, 50%, and 50% mail order). $8,4000 maximum out-of-pocket expenses.
AmeriHealth IHC Silver EPO HSA Local Value $50/$75 -- $50 and $75 office visit copays. Urgent Care copay is $85. $2,300 deductible and 30% and 50% coinsurance. Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order). $7,200 maximum out-of-pocket expenses.
AmeriHealth IHC Silver EPO HSA Regional Preferred $50/$75 -- $50 and $75 office visit copays. Urgent Care copay is $85. $2,300 deductible and 30% and 50% coinsurance. Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order). $7,200 maximum out-of-pocket expenses.
Oscar Simple -- Office visits subject to deductible and coinsurance. Virtual office visits (Oscar Virtual Care) covered at 100%. $2,500 deductible with 40% coinsurance. $50 pcp office visit copay (subject to deductible). $7,200 maximum out-of-pocket expenses.
Oscar Silver Simple -- PCP Saver Plan -- $30 and $75 office visit copays. $75 Urgent Care copay. $2,500 deductible and 50% coinsurance. Generic, preferred and non-preferred drug copays are $25, 50%, and 50% ($62.50, 50%, and 50% mail order). $8,900 Maximum out-of-pocket expenses.
Oscar Silver Classic $0 Ded Plan -- $30 and $75 office visit copays. $75 Urgent Care copay. $0 deductible and 50% coinsurance. Generic, preferred and non-preferred drug copays are $20, 50%, and 50% ($60, 50%, and 50% mail order). $9,100 Maximum out-of-pocket expenses. $60 copay for diagnostic tests.
Oscar Silver Classic Plan -- $30 and $75 office visit copays. $75 Urgent Care copay. $2,500 deductible and 50% coinsurance. Generic, preferred and non-preferred drug copays are $25, 50%, and 50% ($62.50, 50%, and 50% mail order). $8,900 Maximum out-of-pocket expenses. $75 copay for diagnostic tests.
Horizon BCBSNJ OMNIA Silver HSA -- HSA-eligible plan with $2,000 deductible and 30% coinsurance. $15 and $30 office visit copays after deductible has been met. $5 telemedicine visit copay. $9,100 maximum out-of-pocket expenses.
Horizon BCBSNJ OMNIA Silver -- $30 and $50 office visit copays. $75 Urgent Care copay. $1,700 deductible and 50% coinsurance. Generic, preferred and non-preferred drug copays are $20, 50%, and 50% ($40, 50%, and 50% mail order). $15 telemedicine visit copay. X-ray and blood work fully covered at home, office, or independent lab with $100 copay after deductible is met. $9,100 maximum out-of-pocket expenses.
Horizon BCBSNJ OMNIA Advantage EPO Silver -- $30 and $60 office visit copays. $2,500 deductible and 50% coinsurance. Urgent Care copay is $75. Generic, preferred and non-preferred drug copays are $20, 50%, and 50% ($40, 50%, and 50% mail order). $15 telemedicine visit copay. X-ray and blood work fully covered at home, office, or independent lab with $100 copay after deductible is met. $9,100 maximum out-of-pocket expenses.
Horizon BCBSNJ OMNIA Silver Value -- $30 pcp office visit copay. $2,000 deductible and 40% coinsurance. No charge for diagnostic tests performed in office or independent laboratory. Prescription drugs are subject to deductible and coinsurance. $15 telemedicine visit copay.
Ambetter Balanced Care 1003 -- $50 pcp office visit copays. $2,500 deductible and 40% coinsurance.
Ambetter Balanced Care 1007 -- $30 and $75 office visit copays. $2,500 deductible and 50% coinsurance. Urgent Care copay is $75. Generic drug copay is $22.60. $0 telemedicine visit copay. X-ray and blood work copays are $20 and $75.
Oxford Health Silver Copay Select 80 -- Deductible and coinsurance applies to office visits. $25 and $50 generic and preferred drug copays. $2,250 deductible with 20% coinsurance.
Oxford Health Silver Copay Select 70 -- Deductible and coinsurance applies to office visits. $25 and $50 generic and preferred drug copays. $2,500 deductible with 30% coinsurance.
Gold Tier
Oscar Gold Classic -- PCP Saver Plan -- $10 and $50 office visit copays. $75 Urgent Care copay. $1,750 deductible and 20% coinsurance. $50 copay for diagnostic tests (x-rays and blood work). Generic drug copay is $10 ($30 mail order). $7,000 maximum out-of-pocket expenses.
Oscar Gold Classic Plan -- $25 and $75 office visit copays. $75 Urgent Care copay. $2,000 deductible and 50% coinsurance. $75 copay for diagnostic tests (x-rays and blood work). Generic drug copay is $25 ($75 mail order). $5,700 maximum out-of-pocket expenses.
Horizon BCBSNJ OMNIA Gold BlueCard -- $10 and $25 office visit copays. $950 deductible and 30% coinsurance. Urgent Care copay is $50. Diagnostic test copay is $0 for office and independent labs. Imaging copay is $20. Generic, preferred and non-preferred drug copays are $20, $50, and $75 ($40, $100, and $150 mail order). $4,500 maximum out-of-pocket expenses. $100 ER copay.
AmeriHealth IHC Gold HMO Regional Preferred $20/$50 -- $20 and $50 office visit copays. $2,000 deductible and 40% coinsurance. $50 copay for diagnostic tests. $100 imaging copay. Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order). $7,000 maximum out-of-pocket expenses. $75 Urgent Care copay.
AmeriHealth IHC Gold EPO Regional Preferred $30/$50/20% -- $30 and $50 office visit copays. $1,500 deductible and 20% coinsurance. $75 Urgent Care copay. $50 copay for diagnostic tests. $100 imaging copay. Generic, preferred and non-preferred drug copays are $10, 50%, and 50% ($20, 50%, and 50% mail order). $7,000 maximum out-of-pocket expenses. $75 Urgent Care copay.
Ambetter Secure Care 1008 -- $0 and $50 office visit copays. $1,750 deductible and 20% coinsurance. Urgent Care copay is $75. Generic drug copay is $9.40. $0 telemedicine visit copay. X-ray and blood work copays are $20 and $50. Maximum out-of-pocket expenses of $7,550.
Sample Under Age-65 Monthly Rates (Approved by the NJ Department of Insurance)
35-Year-Old Residing In Bergen County ($34,000 Household Income)
$59 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75
$89 -- Oscar Bronze Classic
$90 -- Horizon BCBSNJ Omnia Bronze
$91 -- AmeriHealth IHC Silver EPO HSA Local Value $50/$75
$122 -- Horizon BCBSNJ OMNIA Silver Value
$129 -- Ambetter Balanced Care 1003
45-Year-Old Residing In Monmouth County ($40,000 Household Income)
$126 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75
$162 -- Oscar Bronze Classic
$164 -- Horizon BCBSNJ Omnia Bronze
$164 -- AmeriHealth IHC Silver EPO HSA Local Value $50/$75
$200 -- Horizon BCBSNJ OMNIA Silver Value
$208 -- Ambetter Balanced Care 1003
55-Year-Old Residing In Middlesex County ($47,000 Household Income)
$151 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75
$185 -- AmeriHealth IHC Silver EPO HSA Local Value $50/$75
$240 -- Oscar Bronze Classic
$243 -- Horizon BCBSNJ Omnia Bronze
$243 -- AmeriHealth IHC Bronze EPO HSA Local Value 50%/50%
$258 -- AmeriHealth IHC Silver EPO AmeriHealth Advantage $25/40%
50-Year-Old Married Couple (2 Persons) Residing In Essex County ($60,000 Household Income)
$252 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $25/$50
$304 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75
$362 -- Horizon BCBSNJ OMNIA Bronze
$395 -- AmeriHealth IHC Bronze EPO HSA Local Value 50%/50%
$447 -- Horizon OMNIA Silver Value
55-Year-Old Married Couple With Two Children (4 Persons) Residing In Hudson County ($94,000 Household Income)
$369 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $25/$50
$456 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75
$553 -- Horizon BCBSNJ OMNIA Bronze
$608 -- AmeriHealth IHC Bronze EPO HSA Local Value 50%/50%
$695 -- Horizon OMNIA Silver Value
New Jersey Health Insurance Base Rates (Monthly)
Catastrophic Tier
$216.99 -- Oscar Secure
$248.88 -- Horizon Advantage EPO Essentials
$272.63 -- AmeriHealth IHC Local Value Simple Saver
Bronze Tier
$249.32 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $25/$50
$263.85 -- AmeriHealth IHC Bronze EPO HSA AmeriHealth Advantage $50/$75
$280.15 -- Horizon OMNIA Bronze
$289.25 -- AmeriHealth IHC Bronze EPO HSA Local Value 50%/50%
$308.83 -- AmeriHealth IHC Bronze EPO Local Value $50/$75
$312.12 -- Oscar Bronze Classic
$372.59 -- Horizon Advantage EPO Bronze
$821.16 -- Oxford Health Bronze Copay Select 50
Silver Tier
$287.25 -- AmeriHealth IHC Select Silver EPO AmeriHealth Advantage $25/$60
$295.03 -- AmeriHealth IHC Select Silver EPO HSA AmeriHealth Hospital Advantage $50/$75
$303.09 -- AmeriHealth IHC Select Silver HMO Local Value $50/$75
$303.80 -- Horizon OMNIA Silver Value
$316.68 -- AmeriHealth IHC Silver EPO AmeriHealth Advantage $25/$50
$327.28 -- Oscar Silver Classic Off-Ex Only
$329.88 -- AmeriHealth IHC Silver EPO HSA AmeriHealth Hospital Advantage $50/$75
$337.58 -- AmeriHealth IHC Silver HMO Local Value $50/$75
$350.73 -- Horizon OMNIA Silver HSA
354.34 -- Oscar Silver Saver
$369.04 -- Oscar Silver Classic
$371.55 -- Horizon OMNIA Silver
$387.53 -- Oscar Silver Classic $0 Ded
$412.36 -- AmeriHealth IHC Silver EPO HSA Local Value $50/$75
463.32 -- Horizon Advantage EPO Silver
$548.64 -- AmeriHealth IHC Silver HMO Regional Preferred $50/$75
$702.03 -- AmeriHealth IHC Silver EPO Regional Preferred $50/$75
$849.21 -- Oxford Health Silver Copay Select 70
$879.81 -- Oxford Health Silver Copay Select 80
Gold Tier
$498.52 -- Oscar Classic Gold Option 1
$507.49 -- Oscar Classic Gold Option 2
$510.23 -- Horizon HMO Gold
$605.70 -- Horizon OMNIA Gold
$659.06 -- AmeriHealth IHC Gold HMO Regional Preferred $20/$50
$725.45 -- AmeriHealth IHC EPO Gold Regional Preferred $30/$50
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)
Plan A
$97 -- AARP-UnitedHealthcare
$107 -- Amerihealth
$107 -- Humana
$115 -- Aetna
$116 -- Philadelphia American
$118 -- Accendo
$120 -- National Health
$127 -- Lumico Life
$128 -- Cigna
$129 -- Omaha Insurance
$130 -- Manhattan Life
$130 -- United States Fire
$132 -- Capitol Life
$140 -- Banker's Fidelity Life
$143 -- United American
$144 -- Central States
$144 -- Union Security
$174 -- Americo
Plan B
$130 -- Aetna
$135 -- AARP-UnitedHealthcare
$156 -- United States Fire
$179 -- Humana
Plan C
$146 -- Accendo
$152 -- Lumico Life
$162 -- Manhattan Life
$162 -- Capitol Life
$165 -- Humana
$166 -- National Health
$166 -- AARP-UnitedHealthcare
$173 -- Aetna
$178 -- Union Security
$178 -- AmeriHealth
$181 -- Bankers Fidelity
$189 -- Philadelphia American
$190 -- Humana
$191 -- Omaha Insurance
$202 -- Americo
$208 -- United American
$208 -- United American
$210 -- Combined Insurance
$211 -- Colonial Penn
$248 -- Horizon BCBS
Plan F
$147 -- Accendo
$150 -- Humana
$153 -- Lumico Life
$154 -- Manhattan Life
$155 -- Capitol Life
$158 -- United States Fire
$158 -- National Health
$158 -- AARP-UnitedHealthcare
$159 -- Central States
$164 -- Aetna
$169 -- Bankers Fidelity
$169 -- Omaha Insurance
$169 -- Union Security
$170 -- AmeriHealth
$172 -- Cigna
$185 -- Philadelphia American
$197 -- Humana
$210 -- United American
Plan F (HD)
$46 -- Colonial Penn
$49 -- Philadelphia American
$51 -- United American
$52 -- Banker's Fidelity
$54 -- Mutual Of Omaha
$62 -- Humana
$66 -- Aetna
Plan G
$114 -- Equitable National Life
$131 -- Individual Assurance
$131 -- Pan-American Life
$134 -- National Health
$134 -- Shenandoah Life
$134 -- Western United Life
$135 -- Aetna
$135 -- Manhattan Life
$136 -- Mutual Of Omaha
$136 -- AARP-UnitedHealthcare
$141 -- Horizon BCBS
$141 -- Thrivent
$142 -- Liberty Bankers Life
$143 -- Banker's Fidelity
$156 -- Combined Insurance
Plan N
$81 -- Equitable National Life
$96 -- Aetna
$104 -- Horizon BCBS
$106 -- Shenandoah Life
$108 -- Manhattan Life
$109 -- Mutual Of Omaha
$109 -- Colonial Penn
$110 -- Pan-American Life
$111 -- AARP-UnitedHealthcare
$113 -- Americo
$113 -- Banker's Fidelity
$114 -- Renaissance Life
$115 -- Thrivent
$118 -- AmeriHealth
Sample NJ Medicare Supplement Monthly Preferred Rates (Prices Based On Male Age 65)
Plan A
$107 -- AmeriHealth
$115 -- AARP-UnitedHealthcare
$119 -- Horizon BCBS
$124 -- Equitable National Life
$133 -- Aetna
$145 -- Manhattan Life
$145 -- Philadelphia American
$150 -- Shenandoah Life
$158 -- United American
$159 -- Mutual Of Omaha
$165 -- Thrivent
$168 -- Humana
$169 -- Liberty Bankers Life
$174 -- Colonial Penn
$187 -- Americo
Plan B
$150 -- Aetna
$158 -- AARP-UnitedHealthcare
$183 -- Humana
$211 -- Colonial Penn
Plan C
$178 -- AmeriHealth
$198 -- AARP-UnitedHealthcare
$199 -- Aetna
$232 -- Americo
Plan F
$165 -- Horizon BCBS
$170 -- AmeriHealth
$173 -- Equitable National Life
$178 -- GCU
$189 -- AARP-UnitedHealthcare
$190 -- Aetna
$192 -- Manhattan Life
$195 -- Shenandoah Life
$196 -- National Health Insurance
$199 -- Mutual Of Omaha
$202 -- Western United Life
$205 -- Liberty Banker's Life
$208 -- Thrivent
$210 -- Philadelphia American Life
$212 -- Humana
$212 -- Renaissance Life
$216 -- Pan-American Life
$219 -- Americo
$241 -- United American
Plan F (HD)
$52 -- Philadelphia American
$54 -- Colonial Penn
$58 -- Mutual Of Omaha
$58 -- Banker's Fidelity
$59 -- United American
$61 -- National Health
$62 -- Humana
$76 -- Aetna
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.
New Jersey Prescription Drug Plans (Part D)
Of the 21 available plans (CMS Region 4), 5 offer premiums less than $25. The cheapest monthly rate is $0 and the most expensive monthly rate is $130.80. The average monthly cost is $63.18 Four plans reduced their 2024 rates while 17 plans increased their rate. The least expensive plans are WellCare Value Script ($0), SilverScript SmartSaver ($12.40), Cigna Saver Rx ($16.80), Clear Spring Health Value Rx ($24.30), and Mutual Of Omaha Rx Essential ($24.40).
WellCare Value Script -- $0 monthly premium. $545 deductible with preferred generic, generic, and preferred brand drug copays of $0, $4, and 25%. Non-preferred drug coinsurance is 50%. 3,387 formulary drugs offered. 315 Tier 1 drugs are available.
WellCare Classic -- $35.20 monthly premium. $545 deductible with preferred generic, generic, and preferred brand drug copays of $0, $5, and 22%. Non-preferred drug coinsurance is 43%. 3,020 formulary drugs offered. 125 Tier 1 drugs are available.
WellCare Medicare Rx Value Plus -- $79 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $0, $4, and $47. Non-preferred drug coinsurance is 50%. 3,384 formulary drugs offered. 328 Tier 1 drugs are available.
Cigna Secure-Essential Rx -- $34.90 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $0, $10, and $40. 3,170 formulary drugs offered.
Cigna Secure Rx -- $38.20 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $1, $2, and $30. 3,190 formulary drugs offered.
Cigna Extra Rx -- $64.80 monthly premium. $100 deductible with preferred generic, generic, and preferred brand drug copays of $4, $10, and $42. 3,271 formulary drugs offered.
Humana Walmart Value Rx Plan -- $22.70 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $1, $4, and 14%. 3,221 formulary drugs offered.
Humana Premier Rx Plan -- $76.50 monthly premium. $445 deductible with preferred generic, generic, and preferred brand drug copays of $1, $4, and $45. 3,281 formulary drugs offered.
Humana Basic Rx -- $38.60 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $0, $1, and 19%. 3,104 formulary drugs offered.
Mutual Of Omaha Rx Premier-- $37.10 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $0, $13, and 23%. 3,018 formulary drugs offered.
Mutual Of Omaha Rx Plus-- $91.70 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $1, $3, and 18%. 2,970 formulary drugs offered.
AARP MedicareRx Walgreens-- $29.30 monthly premium. $310 deductible with preferred generic, generic, and preferred brand drug copays of $0, $10, and $40. 3,166 formulary drugs offered.
AARP MedicareRx Saver Plus-- $37.20 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $1, $6, and $33. 3,165 formulary drugs offered.
AARP MedicareRx Preferred-- $100.20 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $5, $10, and $45. 3,583 formulary drugs offered.
SilverScript Choice -- $35.10 monthly premium. $480 deductible with preferred generic, generic, and preferred brand drug copays of $0, $5, and 17%. 3,108 formulary drugs offered.
SilverScript Plus -- $101.40 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $0, $2, and $47. 3,278 formulary drugs offered.
Horizon Medicare Blue Rx Standard -- $70.20 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $0, $5, and $28.
Horizon Medicare Blue Rx Enhanced -- $115.70 monthly premium. $0 deductible with preferred generic, generic, and preferred brand drug copays of $0, $5, and $40.
Medicare Rx Basic -- $37.20 monthly premium. $350 deductible with preferred generic, generic, and preferred brand drug copays of $1, $2, and $31.
EnvisionRxPlus -- $37.70 monthly premium. $435 deductible with preferred generic, generic, and preferred brand drug copays of $1, $3, and 15%.
NJ Medicare Advantage Plans
Rates, benefits, and contract availability can vary, depending upon county of residence. Shown below are many available options with prescription drug coverage included.
AARP Medicare Advantage Plan 1 -- $0 monthly premium with $0 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 $335 for first six days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$30. Tier 1, Tier 2, Tier 3, and Tier 4 30-day preferred pharmacy drug copays are $0, $12, $45, and $95. Some coverage provided for short-duration meals, annual physicals, telehealth visits, and worldwide emergency transportation. $225 ground ambulance copay.
AARP Medicare Advantage Plan 2 -- $33 monthly premium with $0 deductible. Pcp and specialist office visit copays are $0 and $20. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $395 for first five days. 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 $0, $12, $45, and $95. Some coverage provided for short-duration meals, annual physicals, telehealth visits, and worldwide emergency transportation. $225 ground ambulance copay.
AARP Medicare Advantage Plan 3 -- $79 monthly premium with $0 deductible. Pcp and specialist office visit copays are $0 and $15. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $225 for first five days. 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 $0, $10, $47, and $95. Some coverage provided for short-duration meals, annual physicals, telehealth visits, and worldwide emergency transportation. $250 ground ambulance copay.
AARP Medicare Advantage Choice Premier -- $35 monthly premium with $300 deductible. Pcp and specialist office visit copays are $0 and $20. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $225 for first five days. 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 $0, $10, $47, and $95. Some coverage provided for short-duration meals, annual physicals, telehealth visits, and worldwide emergency transportation.
AARP Medicare Advantage Choice -- $0 monthly premium with $0 deductible. Pcp and specialist office visit copays are $0 and $40. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $390 for first five days. 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 $0, $12, $45, and $95. Some coverage provided for short-duration meals, annual physicals, telehealth visits, and worldwide emergency transportation. $250 ground ambulance copay.
Aetna Medicare Credit Value -- $0 monthly premium with $200 deductible. Pcp and specialist office visit copays are $25 and $50. Urgent Care and emergency care copays are $25-$50 and $90. Inpatient hospital copay is $475 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 $0, $10, $47, and $100.
Aetna Medicare Explorer Elite -- $0 monthly premium with $200 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 $790. 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 $0, $10, $47, and $100.
Aetna Medicare Prime Value -- $0 monthly premium with $300 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 Prime Premier (HMO) -- $34 monthly premium with $200 deductible. Pcp and specialist office visit copays are $0 and $15. Urgent Care and emergency care copays are $0-$15 and $90. Inpatient hospital copay is $250 for four days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$30. Tier 1, Tier 2, Tier 3, and Tier 4 30-day preferred pharmacy drug copays are $0, $10, $47, and $100.
Aetna Medicare Prime Premier (PPO) -- $49 monthly premium with $200 deductible. Pcp and specialist office visit copays are $5 and $20. Urgent Care and emergency care copays are $5-$20 and $90. Inpatient hospital copay is $250 for four days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with copays ranging from $0-$30. Tier 1, Tier 2, Tier 3, and Tier 4 30-day preferred pharmacy drug copays are $0, $10, $47, and $100.
Aetna Medicare Explorer Premier Plus -- $36 monthly premium with $350 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 $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 $0, $0, $47, and $100.
Amerivantage Classic -- $0 monthly premium with $200 deductible. Pcp and specialist office visit copays are $5 and $35. Urgent Care and emergency care copays are $65 and $90. Inpatient hospital copay is $350 for first 5 days. 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 -- $22.40 monthly premium with $435 deductible. Pcp and specialist office visit copays are $0 and $35. 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, $13, $47, and $95.
Clover Health Classic (HMO) -- $0 monthly premium with $0 deductible. Pcp and specialist office visit copays are $0 and $20. Urgent Care and emergency care copays are $40 and $90. Inpatient hospital copay is $250 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 $20. 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) -- $35.50 monthly premium with $435 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 $0-$150 copays. Tier 1, Tier 2, Tier 3, and Tier 4 30-day preferred pharmacy drug copays are $0, 22%, 22%, and $25%.
Erickson Advantage Freedom -- $60.00 monthly premium with $200 deductible. Pcp and specialist office visit copays are $10-$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, $15, $45, and $85.
Erickson Advantage Liberty With Drugs -- $25.00 monthly premium with $250 deductible. Pcp and specialist office visit copays are $20-$30 and $50. Urgent Care and emergency care copays are $30 and $75. Inpatient hospital copay is $300 for first 7 days. Outpatient x-rays, lab services, and diagnostic tests and procedures are covered with $0-$20 copays. Tier 1, Tier 2, Tier 3, and Tier 4 30-day preferred pharmacy drug copays are $5, $25, $45, and $100.
Horizon Medicare Blue Advantage -- $0 monthly premium with $250 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 -- $196.40 monthly premium with $435 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 $0, $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 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.
NJ FamilyCare Monthly Income Requirements
Adults Age 19-64 0%-138% FPL
$1,468 -- 1 Family Member
$1,983 -- 2 Family Members
$2,498 -- 3 Family Members
$3,013 -- 4 Family Members
$3,529 -- 5 Family Members
$4,044 -- 6 Family Members
Plan First 138%-205% FPL
$2,180 -- 1 Family Member
$2,946 -- 2 Family Members
$3,711 -- 3 Family Members
$4,476 -- 4 Family Members
$5,242 -- 5 Family Members
$6,077 -- 6 Family Members
Pregnant Women 0%-205% FPL
N/A -- 1 Family Member
$2,946 -- 2 Family Members
$3,711 -- 3 Family Members
$4,476 -- 4 Family Members
$5,242 -- 5 Family Members
$6,077 -- 6 Family Members
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.