If You’re Looking for Health Care Coverage, Here’s Your One Chance to Go Shopping
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Five things you need to know to make open enrollment work for you.
By Thomas Vincz, Public Relations Manager
If you are one of the more than 300,000 New Jerseyans who buy their own health insurance through the individual market, it’s open enrollment season again. From November 1 until December 15, 2019, it’s your one chance to compare options and commit to a health plan that is right for you and your family.
Here are five things you should know that can make your experience easier and help you find a plan that fits your health goals and your wallet.
1. Coverage isn’t optional.
Last year, New Jersey passed a law – the “individual mandate” – requiring almost every state resident to have health insurance. If you don’t get coverage from your employer or qualify for Medicare or Medicaid, you need to select a health plan during open enrollment. If you don’t, you will face a penalty when you pay your state taxes.
The good news is that the mandate, along with a new state reinsurance program also created by Gov. Phil Murphy in 2018, has helped to stabilize the state’s insurance market and lowered the cost of health plans. These changes, according to state officials, mean that premiums for 2020 will be 1.4 percent lower on average than they were in 2018.
2. You can find out the price of your plan in under two minutes.
Most consumers who purchase insurance through the Affordable Care Act can qualify for federal assistance that can lower their cost. “About 80 percent of consumers are eligible to receive financial assistance that lowers, and, in many cases, eliminates almost completely their cost. Unfortunately, many consumers still don’t know this or don’t know how to take advantage of this assistance,” said Michael J. Considine, Vice President of Consumer, Small Group and Mid-Sized Markets for Horizon Blue Cross Blue Shield of New Jersey. “That’s why we’ve launched a new online tool that provides people an estimate of what they’ll actually pay in less than two minutes.”
To get an estimate of a plan’s price, including any available financial assistance, consumers can enter a few pieces of information into Horizon BCBSNJ’s online shopping site, which also offers comprehensive information about the plan options offered by the state’s largest health insurer.
“Most people shop and buy their plan online, so we’ve overhauled the online experience this year to better guide shoppers through the enrollment process,” Considine noted.
Since the introduction of Affordable Care Act plans in 2014, more New Jerseyans have chosen a plan from Horizon BCBSNJ than from any other health insurer.
“People know and trust Horizon because we’ve been singularly focused on improving the health of New Jersey for 87 years and no one has more experience supporting the health needs of individual policy purchasers than we do,” added Considine.
3. Every season brings new plans, including ones that could be better for you.
If you’re happy with your current plan, and it’s still offered, re-enrolling should be simple. But, most consumers have found it’s worthwhile to take open enrollment as an opportunity to consider their options and to make sure that they choose a health plan that is best suited to their health and financial needs.
Take, for example, the OMNIA Health Plans from Horizon BCBSNJ. More individuals have selected one of the OMNIA Health Plans than any other, making them the most popular choice among quality and cost-conscious consumers.
OMNIA Health Plans typically carry a lower premium than the other plans offered by Horizon BCBSNJ, but they give members more power to control their out-of-pocket costs by choosing certain doctors and hospitals. OMNIA Health plans also provide full coverage at every hospital in New Jersey and with every physician participating in Horizon’s Managed Care Network, the largest offered by any health insurer in the state.
It’s that flexibility, affordability and control that Considine believes makes these plans so popular with New Jersey consumers.
“Our customers love their OMNIA Health Plans because they provide access to the largest network of doctors, but they also give them greater control of their out-of-pocket expenses,” he offered.
He also noted that Horizon BCBSNJ’s health plans had the lowest average price change among all of the insurers serving New Jersey’s individual market. “Cost is a significant issue and no one is doing more to deliver value and quality to individual consumers than Horizon,” said Considine. As an example, he cited Horizon’s new OMNIA Silver Value plan, which costs 15 percent less than its OMNIA Silver plan and 30 percent less than the traditional Horizon Advantage EPO Silver plan.
4. There are more ways to protect your health.
Many NJ consumers use open enrollment as a time to make sure they not only comply with the requirement to have health insurance, but also to secure coverage that meets needs not included in a traditional health plan like dental or vision coverage. These options do not appear on the federal marketplace, but insurers who offer these types of coverage typically include them on their own websites.
For example, Horizon BCBSNJ’s website lets consumers review the low-cost dental and vision plans it offers to individuals and gives them the option of conveniently bundling either or both with a health plan. Consumers can also choose these dental or vision plans even if they select a different company for their base health plan.
For customers looking for in-person guidance, Horizon BCBSNJ offers that too. Trained and licensed telephone agents are available to answer questions throughout the enrollment period at (800) 224-1234. For a face-to-face experience, shoppers can meet with an agent who is trained to help consumers understand and weigh their options. A list of times and locations throughout New Jersey where members can meet agents, including those who speak Spanish, throughout open enrollment can be found here.
5. It’s now or never (almost).
This six-week period from November 1 to December 15 is the only time during the year you can enroll in an individual market plan, comply with the state law requiring health coverage and avoid paying a penalty to the State. But, there are two significant exceptions:
- If you have what’s called a qualifying life event – such as losing health coverage, moving, getting married, having a baby, or adopting a child – you have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next open enrollment period to apply. That means that you will both pay a penalty to the State and also risk having to pay for any health care you might need – including typically expensive emergency room visits – on your own.
- You are or become eligible for Medicaid or the State’s NJ FamilyCare program, which accepts enrollment year-round.
The bottom line? Don’t wait to shop or sign up for coverage. Get started here.