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All SHBP/SEHBP plans are self-funded, which means that the money paid out for benefits comes directly from a SHBP/SEHBP fund supplied by the State, participating local employers, and member premiums.

Resolution to Limit the Selection of Medical Plans

Local government and local education employers may adopt a resolution to limit the medical plans offered through the SHBP or SEHBP.

  • Local Government Employer Resolution to Limit the Medical Plans Offered through the SHBP
  • Local Education Employer Resolution to Limit the Medical Plans Offered through the SEHBP

Plan Choice

The availability of plans offered to eligible employees may be limited by local employers through the binding collective bargaining process. However, local employers must offer at least one plan from each Category of Plans for a minimum of four plans.

The local employer may, through its sole discretion, impose the provisions of a binding collective bargaining agreement on those employees who have no majority representation for collective bargaining purposes. The local employer may, through the collective bargaining process, offer employees all, a combination of plans, or one plan from each of the four categories of plans. The plans offered may be different for each baragining group.

Employee Contribution Required (As of July 2011)

Under Chapter 78, P.L. 2001, employee contributions for health benefits are required at a specified percentage of the health benefits/prescription drug premiums for a salary range, but not less than 1.5% of salary (as previously required under Chapter 2, P.L. 2010).

For employees employed as of the contribution's effective date (June 28, 2011) the percentage of premium requirement is implemented in a four-year phase-in at contribution levels of 1/4, 1/2, 3/4, and the full amount of the contribution rate during the phase-in years.

For State employees the phase-in period began as of July 1, 2011

For Local government and local education employees the first year phase in begins upon the expiration of the collective negotiations agreement in effect as of June 28, 2011.

For new employees hired on or after June 28, 2011, or after the expiration of a collective negotiations agreement that was in force on June 28, 2011, the employees contribute (without any phase-in) at the full amount of the required contribution rate.

Calculation charts and worksheets reflecting the phase-in of contribution levels for employees employed on the contribution's effective date who will pay 1/4, 1/2, 3/4, and the full amount of the contribution rate during the phase-in years are available on the Division of Pensions and Benefits' Web site.

Waiver of Medical and Prescription Coverage

State employees may waive SHBP medical and prescription drug coverage and will not have to pay the required health benefits contribution, provided that they are covered under a spouse's or partner's employer provided health benefits coverage. SHBP coverage may be resumed if the spouse's or partner's dependent coverage is no longer in effect. An SHBP Waiver form and the appropriate health benefits application are required to be submitted through the employer to the SHBP.

An employer other than the State participating in the SHBp or SEHBP may allow an employee who is covered as a dependent under a spouse's or partner's employer provided health benefits coverage, to waive SHBp or SEHBP health benefits coverage and be reimbursed up to 25 percent of the amount saved by the employer or $5,000, whichever is less. SHBP/SEHBP coverage may be resumed if the spouse's or partner's dependent coverage is no longer in effect. The decision of an employer to allow its employees to waive coverage and the amount of consideration to be paid are not subject to collective bargaining. An SHBP/SEHBP Waiver form and the appropriate application are required to be submitted through the employer to the SHBP.

Available Medical Plan for Part-time Employees of the State and Part-time Faculty Members at Public Institutions of Higher Education

Part-time employees of the State of New Jersey and part-time faculty members employed at New Jersey public institutions of higher education (New Jersey State colleges, State universities, or county community colleges) who are eligible for SHBP coverage under Chapter 172, P.L. 2003, may enroll in a SHBP/SEHBP medical plan and the Employee Prescription Drug Plan, and must pay the full cost of coverage for the level of coverage selected.

Medical Plan Coverage for Intermittent State Employees

Certain intermittent State employees who have worked a minimum of 750 regular pay status hours within the previous fiscal year (i.e., July 1 to June 30) are eligible for enrollment in all plans but Aetna Freedom10 and NJ DIRECT10 and the Employee Prescription Drug Plan. Intermittent employees who maintain 750 hours of work per fiscal year will receive coverage for the next fiscal year.

Intermittent State employees who meet the minimum pay status hours outlined above must also be covered under the labor contract between the CWA and the State of New Jersey that committed the State to provide SHBP coverage to intermittent employees.

Employers must certify that their intermittent employees have at least 750 regular pay status hours in the prior fiscal year to qualify for coverage in subsequent years. The Human Resource Offices of the Department of Labor and the Department of the Treasury will re-certify eligibility of every intermittent employee with SHBP coverage each year.

Medical Plan Coverage for National Guard Members Called to State Active Duty

National Guard members who are called to State active duty for 30 days or more are eligible for enrollment in NJ DIRECT15, Aetna Freedom15, and the Employee Prescription Drug Plan at the State's expense. Members can also enroll eligible dependents at the State's expense. The Department of Military and Veteran's Affairs is responsible for notifying eligible members and for notifying the Division of Pensions and Benefits of members who are eligible.

SHBP/SEHBP Benefits under the Civil Union Law

Chapter 103, P.L. 2006 establishes New Jersey Civil Unions, which are designed to provide the same legal rights and financial benefits currently available to married heterosexual couples to same-sex couples who enter into a civil union. For more information about this legislation, see Fact Sheet #75, Civil Unions.

SHBP/SEHBP Benefits under the Domestic Partnership Act

Under the New Jersey Domestic Partnership Act, SHBP benefits are extended to eligible same-sex domestic partners of State employees and retirees. Local public employers participating in the SHBP/SEHBP are permitted to extend benefits to their employees and retirees through resolution or ordinance. There are certain conditions that must be met in order for the domestic partner of an enrolled member to be eligible for SHBP/SEHBP coverage.

SHBP/SEHBP members must be made aware of the possible federal tax implications of covering a domestic partner under the SHBP (see Fact Sheet #71, Benefits under the Domestic Partnership Act.)

For additional information about the Domestic Partnership Act and its impact on State-administered retirement system pension and benefit issues, including coverage under the State Health Benefits Program, please refer to Fact Sheet #71, Benefits under the Domestic Partnership Act.

Preferred Provider Organization (PPO) — A Brief Introduction

The Preferred Provider Organization (PPO) plans are administered for the SHBP/SEHBP by Aetna and Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). Plans are available nationwide. Members are not required to choose a primary care physician and do not need a referral for IN-NETWORK services under the plans.

Click here for a list of PPO Plans

In-Network Benefits

When a member sees a physician who participates in-network, the member will only pay the appropriate copayment for eligible services.

Members living outside of New Jersey can utilize physicians participating in-network; the member will only pay the appropriate copayment for eligible services.

If the physician does not paricipate in the network, the services will be considered out-of-network.

Members should contact their doctor to see if he or she participates in the network. For specific details on in-network services, members should contact their plan.

Out-of-Network Benefits

Out-of-network benefits allow members to utilize any licensed physician, but they are required to file a claim form. Most eligible out-of-network care is reimbursed at the applicable percentage of “reasonable and customary” allowances after a member’s annual deductible is met. Out-of-network hospital admissions are also subject to a deductible. For specific details on out-of--network benefits, members should contact their plan .

Click here for PPO Copayments and Deductibles

Under out-of-network benefits, your out-of-pocket expenses may substantially increase because you will be charged for any portion of the fee that is above the "resonable and customary" amount allowed by the plan for payment to a provider for a particular service.

For example, if a physician's charge for a surgical procedure is $500 and the "reasonable and customary" allowance is $400, you are responsible for the $100 difference in addition to any coinsurance and deductible amounts.

Health Maintenance Organization Plans (HMO) — A Brief Introduction

The Health Maintenence Organization (HMO) plans have networks that provide services nationwide.

Click here for a list of HMO Plans

Members who enroll in an HMO must select a Primary Care Physician (PCP) from a group of participating providers contracted by the HMO. All services,
except emergencies, are coordinated through the chosen PCP.

The member's PCP will refer the member to a specialist who participates in the HMO network when a specialist's care is required. Both HMOs offer electronic referrals which facilitate the use of specialists.

HMOs have no deductibles or claim forms to file, but members are required to pay a copayment for visits to their PCP or a referred specialist.

For specific details HMO plan benefits, members should contact their plan.

Click here for HMO Copayments

HMO plans require copayments for routine services such as office visits, use of emergency rooms, etc.

High Deductible Health Plans — A Brief Introduction

The SHBP/SEHBP High Deductible Health Plans (HDHP) combine medical benefits, that include prescription drugs, with a tax-advantaged Health Savings Account (HSA).

Click here for a list of HDHP plans

Under a HDHP, members must pay an annual deductible before the medical plan pays for any covered health care costs. Only services that are covered by the plan count toward the annual deductible. Eligible preventive services normally covered at 100 percent and are not subject to the deductible.

Once the entire annual deductible is met, members pay a percentage of the covered health care costs (coinsurance) and your health plan pays the rest — up to any out-of-pocket maximum.

The Health Savings Account (HSA) is a pre-tax personal savings account funded by the member (and employer for the HDHP 1500 plans). HSA funds may be used to pay for qualified medical expenses not covered through your health plan including deductibles, coinsurance, dental or vision care, and other costs as outlined by the IRS.

Click here for High Deductible Health Plans (HDHP) Costs

* HD4000 plans are not offered to SEHBP active employees.

Note: Medicare eligible Retirees cannot enroll in a High Deductible Health Plan.

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Available Prescription Drug Plans

Active Employee Prescription Drug Coverage

The SHBP/SEHBP Prescription Drug Plans are offered to eligible, active State of New Jersey employees and their dependents as a separate drug plan. Local employers may also elect to provide the SHBP/SEHBP Prescription Drug Plans to their employees as a separate prescription drug benefit. For specific details about the Prescription Drug Plans, see the SHBP/SEHBP Prescription Drug Plans Member Handbook.

The Prescription Drug Plans are administered for the SHBP and SEHBP by Medco Health Solutions, Inc., the pharmacy benefit manager for all eligible members.

Detailed information concerning the SHBP/SEHBP Prescription Drug Plans are available in the SHBP Summary Program Description, and in the SHBP/SEHBP Prescription Drug Plans Member Handbook.

Retiree Prescription Drug Coverage

Retirees have access to a separate prescription drug card plan that includes a mail order service. The plan features a three-tiered design. Copayments vary by plan. More information about the benefit is available from the plans.

The SHBP Employee Dental Plans

The SHBP Employee Dental Plans are available to eligible full-time State employees, full-time employees of a local employer (county, municipality, school board, etc.) that elects by resolution to provide the Employee Dental Plans to its employees, and the eligible dependents of these employees. The program provides a choice between two different types of plans, the Dental Expense Plan and Dental Provider Organizations (DPOs). A comparison of the types of plans is found in Fact Sheet #37, Employee Dental Plans. More detailed information is available in the Employee Dental Plans Member Handbook.

Please note that there is one application, the Employee Dental Plans Application, for full-time State employees, full-time employees of a local employer (county, municipality, school board, etc.) that elects by resolution to provide the Employee Dental Plans to its employees, and the eligible dependents of these employees.

Local employers wishing to initiate participation in the Employee Dental Plans should click here for more information about how to elect to participate in the SHBP Employee Dental Plans, including the completion of the Resolution for SHBP Dental Plan Participation.

The Dental Plan Organizations (DPOs) are individual companies offering dental services through contracts with a network of dental providers. A DPO member selects a DPO dentist, and the cost of most diagnostic and preventive services is covered in full, although certain services require an additional copayment. The DPOs operate much like Health Maintenance Organizations in that they will not cover services provided by an out-of-network provider unless there was a proper referral. You must use a dentist who is a member of the DPO you selected or be referred by your DPO dentist. For more information, please see the Employee Dental Plans Member Handbook.

The Dental Expense Plan is a traditional indemnity plan that allows a member to obtain services from any dentist. After the member satisfies a deductible, the member is reimbursed for a percentage of the reasonable and customary charges for the services that are covered under the plan. The Dental Expense Plan has a network of participating providers who offer discounted services. Employees save money by using these providers. This plan is administered under a contract between the State Health Benefits Commission (SHBC) and Aetna Dental. For more information, please see the Employee Dental Plans Member Handbook.

The cost of participation in either plan is shared equally by the State and the employee. Premium payments are made through payroll deductions.

Retiree Dental Expense Plan

The SHBP offers a Retiree Dental Expense Plan to retirees enrolled in, or eligible to enroll in, the Retired Group of the SHBP/SEHBP. Employers should inform employees who are nearing retirement about this plan.The plan is self-insured by the State and is administered for the SHBP by Aetna Dental.

Most retirees pay the full cost of the Retiree Dental Expense Plan (the plan is offered with the understanding that the State will bear no costs for it.) Under certain circumstances, local public employers participating in the SHBP/SEHBP may elect to share the cost of coverage for their retirees through the adoption of the provisions of Chapter 48, P.L. 1999. The following links are made available so that employers can provide additional information about the Retiree Dental Expense Plan to their eligible employees:

Fact Sheet #73, Retiree Dental Expense Plan

Retiree Dental Expense Plan Rates

Retiree Dental Expense Plan Member Handbook

Source


  • Hide caption AnnaBelle Bowers, 87, has lunch with granddaughter Kelley Hawkins in Harrisburg, Pa. Kelley and her sister-in-law, LaDonna Martin, jointly care for AnnaBelle. Previous Next Kainaz Amaria/NPR
  • Hide caption AnnaBelle, affectionately nicknamed "Snootzie," lost her husband years ago and in the past few years has become too frail to live alone. Previous Next Kainaz Amaria/NPR
  • Hide caption LaDonna talks on the phone with Kelley while helping AnnaBelle with her makeup in her family's living room. Previous Next Kainaz Amaria/NPR
  • Hide caption Kelley and LaDonna, both nurses in their 40s with two children each, agree that the decision to take on AnnaBelle's care wasn't an easy financial choice. Above, AnnaBelle's pillbox. Previous Next Kainaz Amaria/NPR
  • Hide caption Every two weeks AnnaBelle rotates from one home to another. After two years of moving her back and forth, LaDonna and Kelley have fine-tuned their routine but still fill an SUV with AnnaBelle's necessities. Previous Next Kainaz Amaria/NPR
  • Hide caption LaDonna speaks with AnnaBelle's longtime physician, Walter Watkin. Previous Next Kainaz Amaria/NPR
  • Hide caption LaDonna and Kelley live minutes away from each other in suburban Harrisburg, making it easy to move AnnaBelle back and forth. Previous Next Kainaz Amaria/NPR
  • Hide caption "I'm not rich moneywise, but with family I'm a millionaire," AnnaBelle says, acknowledging the care she is getting from Kelley (left) and LaDonna (right). Previous Next Kainaz Amaria/NPR
  • Hide caption LaDonna hands AnnaBelle's clothes to Kelley. "I'm hoping my daughters see how we are taking care of Snootzie and treat me the same way," says Kelley. Previous Next Kainaz Amaria/NPR
  • Hide caption Kelley supports AnnaBelle as she goes up the steps entering her family's home. AnnaBelle's mobility is significantly hampered owing to rheumatoid arthritis. Previous Next Kainaz Amaria/NPR
  • Hide caption A younger AnnaBelle smiles with her great-granddaughters Chelsea (left) and Carley (right). Previous Next Kainaz Amaria/NPR
  • Hide caption Kelley's daughter Carley, 17, looks at her prom dress while Kelley tends to AnnaBelle. By next year, Kelley and her husband will have two daughters in college. Previous Next Kainaz Amaria/NPR
  • Hide caption AnnaBelle enjoys a moment with her great-granddaughter and LaDonna's daughter, Lauren, 12. LaDonna says that having AnnaBelle at home has made both sets of children kinder and less self-centered. Previous Next Kainaz Amaria/NPR

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Part of the Family Matters series

An Expert Weighs In

Waiting To Buy Long-Term-Care Insurance Adds Up May 9, 2012

Americans routinely buy all sorts of insurance — for cars, homes, health and even pets and boats.

But when it comes to long-term-care insurance, relatively few sign up. Out of more than 313 million Americans, only about 8 million have any such protection, according to the American Association for Long-Term Care Insurance. The low participation rate largely reflects the high cost of long-term-care insurance.

Geneva Hunter, 66, is among those without protection. She is well aware of how helpful it would be to have such insurance. She gets schooled on that point each day: Her 89-year-old mother, Ida Christian, who has Alzheimer's disease, lives with her.

"I do not have [the insurance] because at the time it was offered [through my company], I could not afford it and take care of my mother at the same time," said Hunter, a member of one of three families being profiled by NPR in a series called Family Matters: The Money Squeeze.

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AnnaBelle Bowers' long-time physician, Walter Watkin, gives her a kiss on the forehead at the end of her visit. When asked how long she had been coming to see him, he said, "Long enough for her file to be 2 inches thick." Kainaz Amaria/NPR hide caption

toggle caption Kainaz Amaria/NPR Mercury car insurance pay online

AnnaBelle Bowers' long-time physician, Walter Watkin, gives her a kiss on the forehead at the end of her visit. When asked how long she had been coming to see him, he said, "Long enough for her file to be 2 inches thick."

Kainaz Amaria/NPR

"I think it was close to $400 a month," Hunter said. "That's a lot of money when you are caring for somebody else."

But with each passing birthday, Hunter feels more pressure to buy insurance. "I know it's expensive, but I have to do it," she says, because she fears becoming a financial burden to her daughter.

Many Americans share that financial goal: to not burden others. But the reality is that each year, an estimated 11 million U.S. adults need some type of long-term care.

Information On Long-Term Care And Insurance

Read more about long-term care, including tips on planning and paying for it, at the National Clearinghouse for Long-Term Care, developed by the U.S. Department of Health and Human Resources. The site also includes information on long-term-care insurance.

Such care can be crushingly expensive: Just one hour of home-health-aide care costs roughly $20, while the average private nursing home room costs $87,000 a year. Neither routine employer-based medical insurance nor Medicare will pay for extended periods of custodial care.

Scott Hawkins, 46, and a member of another family in the NPR series, says he hasn't yet explored getting long-term-care insurance. In fact, future elder-care costs are so daunting that only humor can help defuse the ticking financial bomb.

"Our youngest daughter [Carley] is a little bit of a comedian and she made the comment one time to us, 'Hey, when you guys get old, don't worry about it' — and we were thinking she is going to say something nice," he said. Instead, she suggested her parents plan on living with their older daughter, Chelsea, who is studying to be a pharmacist.

Scott recalls Carley joking that he would "eat better if you live at Chelsea's house because she'll be making twice as much money as I make being a schoolteacher!"

For the nation's roughly 78 million baby boomers, the time for humor about who will prepare their meals is quickly running out. Many boomers, people born between 1946 and 1964, are expected to fall so far into poverty trying to provide themselves with paid care that they will qualify for Medicaid — the medical care program for the deeply impoverished.

A fortunate few will have long-term-care insurance, but even that option is looking sketchy as more companies exit the business. Insurance giants such as Prudential and MetLife have recently pulled back from offering long-term-care policies. Others, such as John Hancock and Genworth Financial, have turned to state regulators, seeking permission to dramatically hike premiums. Depending upon the location, the insurers' requests for higher rates have been for amounts such as 18 percent or 40 percent or, in a few cases, 90 percent.

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Here are answers to some common questions about long-term-care insurance.

What is long-term-care insurance?

This type of policy covers basic daily needs over an extended time. While health care insurance or Medicare helps pay for immediate medical expenses, say, a surgeon's bill, long-term-care insurance helps people cope with the cost of chronic illnesses, such as Alzheimer's disease, or various disabilities. The policies pay for assistance with everything from the basics — bathing and dressing — to skilled care from therapists and nurses for months or even years.

Do you have to be in an institution to collect your benefits?

Long-term-care insurance typically covers out-of-pocket expenses that come with home care, assisted living and nursing homes. Most policies have a waiting period that works like a deductible. So if you need the help of a home-nursing aide, you may have to wait 90 or 120 days before your benefits start to cover those costs.

How much does insurance cost?

The American Association for Long-Term Care Insurance says people should expect to pay an average of $3,335 per year to cover a couple of healthy 60-year-olds on a plan that pays out a $150 daily benefit for up to three years. But prices can vary dramatically, depending upon factors such as the purchasers' age, the level of inflation-adjustment protection and whether the daily benefit will be $100, or some larger amount, say, $150 or $200.

Long-Term-Care Insurance Policy Costs, Values

Compare the costs and coverage offered in a sampling of long-term-care insurance policies.

Age Yearly cost1 Immediate
value2
Value at
age 803
Value at
age 853
Age 55 (single) preferred health $1,720 Range: $1,428 - $2,552 $170,000 $354,000 $418,000
Age 55 (couple) preferred health
(with shared care option)
$2,700 Range: $2,027 - $3,574 $340,000 $708,000 $836,000
Age 60 (couple) preferred health
(with shared care option)
$3,335 Range: $2,700 - $4,204 $340,000 $611,000 $708,000
Age 65 (couple) standard health
(with shared care option)
$4,433 Range: $3,815 - $7,129 $340,000 $533,000 $611,000

Notes

  1. Calculations based on: $150 daily benefit selected at inception of plan, 3-year benefit period, 90-day elimination period, 100 percent home care benefit and 3 percent inflation compounded annually. Includes spousal discount (where applicable) and preferred health discount (when indicated).
  2. Equals available cash value of benefits that would be paid for claim starting at present age (an almost immediate claim). Policies ranged from $162,000 to $200,000 in initial benefits.
  3. Equals available cash value of benefits that would be paid based on 3 percent annual compound growth of policy benefits.
  4. Shared care options vary from company to company. For illustration purposes, this example assumes access to a combined, total pool of funds.

Source: 2012 Long-Term Care Insurance Price Index, American Association for Long-Term Care Insurance

Why is the coverage so expensive?

The premiums are high and rising because providing long-term care can be so risky for the insurer. In contrast, the potential claim on an insured home can be reasonably estimated. If a $100,000 home is burned to the ground, the claim would reflect that amount. But predicting how much care a person might need — and for how long — is not easy.

These days, policies typically are capped at three years because open-ended plans have proved too risky for the insurer. The insurance association points to the case of a woman who purchased coverage at age 43. For three years, she paid her annual premium of $881. Then, she needed care, so she stopped paying premiums and initiated her claim. Her care lasted 15 years and cost the insurer $1.7 million, the association said.

"Insurers paid some $6.6 billion in benefits to roughly 200,000 individuals last year," says Jesse Slome, executive director of the group.

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Family Matters: The Money Squeeze

Family Matters: Meet The Families

When should you get the insurance?

It's cheaper when you sign up by age 60. You have to be medically healthy to qualify. But, like auto insurance, a policy generally has no "surrender" value. That is, if you never have an auto accident, then all the money you spent on car insurance is gone forever. Typically, that's how it works with long-term-care insurance; i.e., you may pay and pay — and never get back a penny if you don't medically qualify for care.

Also, some people pay their premiums for years, and then get hit with rate hikes they can't afford. They then face the tough decision of dropping their policies — and losing any chance of collecting benefits — or trying to struggle on, paying higher rates or accepting lower benefits, such as less inflation-adjustment protection.

Is it worth buying?

Experts say the insurance can be a huge help, especially for people without children and relatively small retirement savings. But it's far from a perfect solution to all problems. For example, a policy typically covers three years of care, but many people live long beyond that cap. And the new policies are being written with more restrictions to limit insurers' risks.

Whether it makes sense to spend so much money on premiums, rather than focus on building up a retirement savings account, is a complicated equation that requires serious study.

Morning Edition producer Jessica Smith contributed to this story.

Source


New Jersey residents continue to buy health insurance in record numbers as the next 2017 open enrollment deadline nears. Shortly after the new year began, 273,210 New Jerseyans had enrolled in health plans through healthcare.gov, the state’s federally facilitated exchange – that’s 15,000 more than this time last year.

But many fear the Affordable Care Act is in jeopardy with president-elect Trump’s promise to repeal and replace it. Should his administration do so, the Urban Institute estimates that 799,000 fewer people in New Jersey would have health insurance in 2019. Currently, an estimated 644,000 are uninsured; that number would jump to 1,443,000.

However, Obamacare remains in effect, and subsidies remain available to those living in New Jersey and elsewhere in the United States. More than 80 percent of those who enroll in 2017 plans through New Jersey’s exchange are expected to receive premium tax credits and more than half will receive cost-sharing reductions as well. To learn more about the potential impact of a Trump repeal, read our post about the “Trump effect.”

You have until January 15 to enroll in coverage that begins February 1. Open enrollment for 2017 ends January 31.

2017 open enrollment plans, rates

Many New Jersey exchange carriers will make their exit after 2016. UnitedHealthcare, Oscar and Aetna have all ceased to offer individual plans in certain markets.

Just two carriers offer 2017 plans through New Jersey’s exchange – there were five in 2016:

  • Horizon Blue Cross Blue Shield of New Jersey
  • AmeriHealth of New Jersey

Premiums for the most popular plan, Horizon BCBS, increased less than 5 percent.

New Jersey health ratings

The Commonwealth Fund’s 2015 Scorecard on State Health System Performance rated New Jersey 20th out of the 50 states and District of Columbia – a downward tumble of five positions over last year. New Jersey’s scorecard includes details on how the ratings are calculated.

The state fared even better with America’s Health Rankings, in which New Jersey placed 9th in 2016, an improvement from 11th in 2015. New Jersey’s rating is positively impacted by ready availability of dentists and primary care physicians, as well as a moderate uninsured rate.

Trust for America’s Health also compiled information on the prevalence of a multitude of illnesses and health indicators in New Jersey. The details are available in the 2015 listing of Key Health Data About New Jersey.

Within the state, health factors and outcomes vary from one county to another. You can see health data for New Jersey’s 21 counties with this interactive map created by the Robert Wood Johnson Foundation. In general, most of the northern half of the state ranks higher than most of the southern portion.

New Jersey and the Affordable Care Act

In 2010, New Jersey’s U.S. Senators – Democrats Frank Lautenberg and Robert Menendez – both voted yes on the ACA. In the U.S. House, eight Democrats voted yes, while five Republicans voted no. Lautenberg has since been replaced in the Senate by fellow Democrat Cory Booker, who is supportive of the ACA. The U.S. House now includes six Republicans and six Democrats from New Jersey.

New Jersey’s state legislature has a solid Democratic majority, although Republican Governor Chris Christie is not a fan of the ACA, calling it a “failed federal program” during a town hall meeting in 2014. But he did agree to expand Medicaid under the ACA and has said he’s proud of that accomplishment.

During the 2014 open enrollment period, the first Obamacare open enrollment period, New Jersey’s exchange enrolled nearly 180,000 people in Medicaid by mid-April. The state opted for a federally facilitated exchange, which means HHS runs New Jersey’s health insurance marketplace.

How did Obamacare help New Jersey residents?

New Jersey opted to let the federal government run its health insurance exchange but expanded Medicaid in 2014. Has access to affordable health insurance improved for its residents under the Affordable Care Act?

In 2013, about 14.9 percent of New Jersey residents were uninsured. By mid-2014, six months after most of the ACA’s provisions were implemented, that number had fallen by over three percentage points, to 11.7 percent. The New Jersey exchange enrolled nearly 342,000 people during the first open enrollment period, including Medicaid/CHIP as well as private plans.

In 2015, New Jersey’s percentage of uninsured residents dropped to 9.7 percent, a 5.2 percentage point decrease from 2013 to 2015. Among the other 28 states that did not implement a state-run marketplace or Medicaid expansion or only implemented on of those measures, the average decline was 5.3 percentage points.

New Jersey’s health insurance CO-OP

Health Republic Insurance of New Jersey was the trade name for Freelancer’s CO-OP of New Jersey, a Consumer Oriented and Operated Plan (CO-OP) established under the ACA. CO-OPs in 22 states received a total of $2 billion in grants from the federal government to establish their programs; it is now being liquidated. Freelancer’s CO-OP of New Jersey received $109 million.

Several CO-OPs have announced closure, and New Jersey was among the seven still in operation as of early September 2016. However, on September 12, the NJ Department of Banking and Securities placed Health Republic into rehabilitation and the CO-OP will no longer sell new policies. Existing Health Republic policies will terminate at the end of 2016; as a result, nearly 35,000 individuals will need to find new health plans for 2017.

During the rehabilitation period, state regulators are working to stabilize the company enough for it to return to the marketplace in 2018.

New Jersey enrollment in qualified health plans

During 2014 open enrollment, 161,775 people had enrolled in qualified health plans through New Jersey’s exchange by mid-April, and 84 percent of them had received premium subsidies.

A Kaiser Family Foundation study released in the fall of 2013 found that about 628,000 New Jersey residents would be potential customers for the exchange, and that about 400,000 of them would be eligible to receive premium subsidies. So the state enrolled about a quarter of its eligible population in the first open enrollment period, leaving plenty of room for growth.

A total of 288,573 people enrolled in New Jersey exchange plans during the 2016 open enrollment period.

New Jersey enrollment in qualified health plans

During 2014 open enrollment, 161,775 people had enrolled in qualified health plans through New Jersey’s exchange by mid-April, and 84 percent of them had received premium subsidies.

A Kaiser Family Foundation study released in the fall of 2013 found that about 628,000 New Jersey residents would be potential customers for the exchange, and that about 400,000 of them would be eligible to receive premium subsidies. So the state enrolled about a quarter of its eligible population in the first open enrollment period, leaving plenty of room for growth.

A total of 288,573 people enrolled in New Jersey exchange plans during the 2016 open enrollment period.

New Jersey Medicaid/CHIP enrollment

New Jersey’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in reducing the state’s uninsured population. The ACA provided for Medicaid expansion in all states, but in 2012 the Supreme Court ruled that states could opt out, and 20 states have thus far avoided any type of Medicaid expansion.

In early 2014, a Kaiser Family Foundation report estimated that about 38 percent of the 1.3 million non-elderly uninsured residents in New Jersey would be eligible for Medicaid or CHIP under the expanded eligibility guidelines created by the ACA. As of mid-April 2014, 179,872 people had enrolled in Medicaid through the New Jersey exchange.

New Jersey Medicaid enrollment increased 37 percent from 2013 to June 2016. Enrollment in Medicaid is year-round, so that number has continued to increase, chipping away further at the state’s uninsured rate.

Medicare enrollment in the state of New Jersey

As of May 2015, New Jersey Medicare enrollment was nearly 1.5 million – about 17 percent of the state population compared with 17 percent of the U.S. population enrolled in Medicare.

About 87 percent of New Jersey Medicare beneficiaries qualified based on age alone, while the remaining 13 percent were eligible due to disability.

Per-enrollee Medicare spending for New Jersey trends higher than the national average at $9,686 per year compared with $8,970. As of 2009, the state ranked 9th in the nation for overall Medicare spending.

Medicare Advantage plans offer New Jersey Medicare participants a way to gain more healthcare benefits; they are an alternative to Original Medicare. In New Jersey, 15 percent of Medicare enrollees select a Medicare Advantage plan.

Medicare Part D plans offer New Jersey Medicare recipients stand-alone prescription drug coverage. In 2015, Part D enrollees accounted for 60 percent of New Jersey’s total Medicare population.

State healthcare legislation

Here’s a summary of recent New Jersey bills related to public health and healthcare reform:

Source

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