New Jersey insurance law and regulation
News that affects your health insurance and planning
December 28, 2020 – The New Jersey Department of Banking and Insurance took legal action against companies marketing Trinity HealthShare, a faith-based heath care sharing ministry that does not meet the legal requirements for health insurance in the state. While it’s not illegal to market supplemental or non-insurance health plans, it is important that consumers understand the limitations before they need care that is not provided by their plan. Also it is important for these members to recognize the financial reality that if another member has a catastrophic medical need then there is no expectation that payment would be available for their own medical care. In other words, these plans are based on the faith that the cost of medical will not exceed the plans expectations. Freedom Benefits offers help with insured plans and uninsured options to supplement faith-based plans.
The history of health care planning in New Jersey (Information is outdated and links may be expired)
2/26/2017 Protests continued throughout the state over the proposed repeal of the Affordable Care Act. For those who are eager to leave the plan, alternatives to Obamacare are now avalailable.
1/1/2015 Enrollments are off to a slow start at Healthcare.gov for 2015. Yesterday the federal government released surprising year-end results of Healthcare.gov saying that so far only 105,000 New Jersey residents signed up for health insurance coverage for 2015 compared to 160,000 last year. We might have expected the number to increase this year especially since most of those enrolling for coverage on the exchange have their premium fully or partially paid through government subsidies. There are more plan choices available for 2015 and the rate increases have been modest. Additionally, the 2015 tax penalty for not having health insurance coverage rose sharply, now approaching 2% of gross income, so we might have expected this larger penalty to motivate more uninsured residents to enroll. It is possible that the decline is due to reduced advertising budget of the federal Health Insurance Marketplace this year compared to 2013-2014. The Healthcare.gov report confirms that the majority of those signing up this year were simply re-enrolling from last year. It is unclear whether the decline in online enrollment is partly due to some individuals whose plans might have automatically enrolled from 2014 to 2015. It is also possible that the federal report does not reflect the results of the state’s rapid recent expansion of Medicaid enrollments.
Individuals have until February 15 to enroll and avoid the 2015 tax penalty. New Jersey apparently still has about a million people without health insurance (There may be other issues complicating accurate reporting of the actual number of uninsured). While the number of uninsured has fluctuated over the past decade, especially in reaction to the various stages in the implementation of the Affordable Care Act, there is no clear indication the issue will be resolved by continuing on our present course.
12/27/2014 Summary of New Jersey health insurance issues for 2014:
Exchange results – A higher number of NJ residents now have health insurance than ever before due primarily to the expansion of Medicaid that added coverage for about 400,000 this year. The success rate with working individuals who would need to pay their own insurance premium is not as impressive. Two new insurance companies joined the health insurance marketplace in 2015: Health Republic Insurance of New Jersey and Oscar Health Insurance. Six insurance companies now offer 45 health plans (on average in each county) up from 26 in 2014.
Health and rates – More NJ residents have quit smoking and are taking better care of themselves. Still, more than one out of four NJ residents are obese and that is our biggest public health risk. A growing number of employers and health plans charge higher rates for smokers and overweight members who do not commit to a weight reduction program. Rate increases in most plans have been between 5% and 10%.
Medicare – A third of the state’s hospitals are being penalized by Medicare for sub-standard patient problems that it believes are easily prevented.
Medicaid – One sixth of NJ residents are enrolled in Medicaid. Yet a large backlog of people waiting for coverage still exists. Thousands more have given up hope trying to navigate the red tape that prevents them from obtaining coverage. This link provides some tips for enrolling in Medicaid. At year end, administrative problems continued to plague the state’s Medicaid program as reported by the inquirer Trenton Bureau.
Medical debt – Those without coverage and cash to pay large out-of-pocket costs facing increasing risk of being put into medical collections. A growing number of hospitals now seek wage attachments against those who cannot pay the high out-of-pocket expenses built into Obamacare policies. NJ Family Care coverage can be issued retroactively in some cases to prevent medical and financial disasters. Employers can help by offering supplemental health insurance on a tax free basis to cover high policy deductibles.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
1/13/2014 About 900,000 uninsured New Jersey residents are eligible for coverage under the Affordable Care Act. About 1/3 of these are eligible for government-paid Medicaid. So far, only about 90,000 have enrolled for coverage and even fewer have actually selected and paid for a plan. Medicaid in-person enrollers can be found at www.covernj.org. For those who must pay for their own coverage, many find the average premium of about $150 per person per month to be unaffordable. Out-of-pocket cost plus high policy deductibles commonly raise the total cost of health care above 15% of household income for NJ families.
7/26/2013 Affordable Smart Term Life Insurance is now available to most New Jersey residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
10/4/2012 The New Jersey Senate Democrats passed a new health insurance exchange bill without any support from Republicans. Governor Christie preciously vetoed an exchange bill earlier this year. If the legislation is not passed by November 16 then New Jersey’s insurance exchange bill be managed by the federal government. In that case, the state would forfeit federal funds to develop the exchange and would lose some power to regulate insurance available within the state. The bill provides for the establishment of an exchange that would be governed by a board of 8 members, including 5 members of the public. The board would elect an advisory committee that could include representatives of insurance companies and other stakeholders.
7/19/2012 AmeriHealth NJ announced an innovative voluntary cost control program that enables members to play an active role in selecting where they can receive high-quality and cost-effective advanced diagnostic imaging services when they are needed. The goal of the outreach program is to bridge that price gap by providing members with information that will help them make informed decisions about the health care they receive. Prices can vary by as much 683% more for the same medical procedures, such as MRIs or CT scans, in the same town, depending on the site the medical procedure is performed according to the National Healthcare Group.
2/8/2012 New Jersey took a step forward in the process to establish its own health insurance exchange as Assembly Bill A2171 was voted out of the Health and Senior Services Committee headed by Dr. Herb Canaway, a Democrat from Burlington County. The health insurance exchange will be an online marketplace where individuals and small businesses in New Jersey can buy health insurance starting in 2014. Freedom Benefits noted that the bill provides only makes brief mention of the navigator program that may be the function served by our organization.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Horizon Blue Cross Blue Shield, Oxford Health Plan and Aetna are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
1/19/2012 With just under two year remaining until final individual health insurance reform laws take effect, New Jersey is one of only five states that does not have a short term medical insurance plan available to bridge the gap until affordable basic health insurance becomes available to everyone. Short term medical insurance is popular basic coverage because it is exempt from the restrictions of health reform law and therefore priced less than half of the rate of a plan that includes all state and federally mandated coverage. The lack of short term coverage in the state has boosted medical insurance tourism among those who need immediate coverage for 2012. A policy purchased while residing outside the state provides valid coverage nationwide including within New Jersey.
7/8/2011 A report by Rutgers Center for Center for State Health Policy said that 70% of New Jersey’s adult residents not born in the U.S. lacked health insurance despite coverage available under a variety of Medicaid and commercial programs like Inbound Immigrant insurance.
3/9/2011 New Jersey health insurance exchange plans are beginning to take shape at a high level meeting between a number of independent state agencies. Legislative concern focuses on the expected growth of the number of people on Medicaid along with the 2013 mandate to increase primary care provider reimbursement to the same level as Medicare. Currently the state only pays primary care providers 34% of Medicare rates. The additional cost is not considered in state budgeting.
12/16/2010 New Jersey Department of Banking and Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, New Jersey said that it would: 1) Research the number, demographic and health characteristics of New Jersey residents who will be eligible and likely to enroll in Medicaid or FamilyCare and subsidized and unsubsidized Exchange products (through individual and small employer Exchange(s)) in New Jersey, 2) Conduct forums and on-line surveys to obtain stakeholder input into the design of Exchange(s) in New Jersey, and 3) Engage experts in benefit design, building provider capacity to accommodate the anticipated enrollment, transitioning existing Medicaid clients into the Exchange, coordinating with social services programs, and reviewing alternative delivery models.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in New Jersey is now available at Freedom Benefits.
3/23/2010 The state’s proposed 2011 budget calls for drastic cuts in FamilyCare, the state health program for low income residents.