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Buying your own health insurance? Make sure you get what you bargained for.



There’s a lot at stake when it comes to choosing the right health plan for you and your family. Here are 5 details that can make all the difference when it comes time to use your insurance.

The open enrollment period for Affordable Care Act (ACA), aka “Obamacare” plans is in full swing and there are more choices than ever for New Jersey.  Plans are available directly from Horizon or through GetCoveredNJ, the State’s official health insurance marketplace for individual and family coverage.

Here’s more good news for 2023 plans: Record levels of financial assistance are available—about 9 out of 10 NJ residents qualify for financial assistance that will lower your premium. While cost is always important,  buyers need to pay more attention than ever to some details that can make all the difference when it comes to getting care. 

Here are five things to consider when choosing a plan for your health and budget.

Does your plan include hospitals nearby that you trust?

Unexpected health issues in the coming year are, well, to be expected, to a certain degree. After all, there is no crystal health ball (if only). Some insurance companies lower their premium by cutting hospitals out of their network—oftentimes, the biggest, most comprehensive health systems. That means you will have to choose between paying substantially more—as in thousands of dollars—for care if the hospital you prefer is out-of-network.  With Horizon, every hospital in New Jersey is in-network.

Are your doctors in network?

Just as is the case with hospitals, some insurance companies have cut doctors out of their network as a way to lower premiums.  

Is the doctor you trust in network with the plan you are considering? What about the specialists you would want to see if a need arose? All of Horizon’s plans include all of the doctors in our network—one of the largest in New Jersey.    

Limiting access to doctors and hospitals has serious implications for your health. Saving a few dollars a month might not seem like such a good idea if you can’t see doctors or get care at hospitals you trust.   

Do you have a “tiered” network?

Plans with tiered networks, like Horizon’s OMNIA health plans, give consumers more power over your health spending without sacrificing access to the doctors and hospitals you trust. 

Tiered network plans offer the flexibility to see any in-network health care provider, but have lower deductibles, copays and co-insurance when seeing Tier 1 providers. Tier 2 providers are still in-network and have out-of-pocket costs similar to plans without tiers.

If you’re looking to save a few bucks without sacrificing access to hospitals and doctors, this might strike the right balance for you. There’s a reason that more than half a million people have chosen an OMNIA Health Plan.

What do “zero-cost ” benefits actually mean?

It’s true: Many insurance carriers offer plans promising “free” or “zero-cost” coverage. For example, several carriers offer zero-cost telehealth or virtual visits through a third-party vendor, meaning they are not necessarily with the doctors of your choosing and might not even be in based in New Jersey. But, what if you need to actually SEE a doctor? 

Health insurance is an important choice. Take time to consider the trade-offs and how you’ll feel if the plan you choose doesn’t include the coverage you actually need.

Instead of looking at ways to limit your care, Horizon plans are focused on improving your care. 

For example, starting in 2023, Horizon will be one of the first health insurers in the country to cover birthing doulas for members with an individual or family plan purchased through GetCoveredNJ or directly from Horizon Doulas have been shown to provide physical, emotional and informational support that can improve health for moms and babies.

If you have children, things may be different this year

Recent changes in State law mean that a child eligible for coverage through NJ Family Care will not get any financial support or tax credits to lower the premiums for a plan purchased on the individual market.  If your child qualifies for NJ Family Care and you choose to enroll them in any plan, from any health insurer through GetCoveredNJ, you will pay 100% of the premium for your child. This change does not affect financial assistance or subsidies for adults.

Speaking directly with a plan expert at Horizon can help you determine if your child is eligible for a subsidy.  Call 1-800-224-1234 for help with this, to get answers to other questions about individual health plans, or to learn more about your options.

Remember:  if you don’t have health insurance through an employer or Medicare/Medicaid and buy your own coverage through the individual market, to have coverage starting on January 1, you must have enrolled by December 31, 2022.  Enrolling after the end of the year but before January 31, 2023 means your coverage starts February 1, 2023.