What are the Best Health Insurance Options in New Jersey?
Health Insurance covers the whole or a part of the risk of a person who is incurring medical expenses. The policyholder estimates the overall risk of health care expenses and develops a routine structure to pay for the health care benefits mentioned in the insurance agreement. Health insurance is administered by any central organization such as a government agency, a private business or a non-profit organization. With many entities providing health benefits, it is sometimes confusing and hard for consumers to choose from the available plans.
Marketplace: Government aided healthcare provider
The health insurance provided by the New Jersey government depends on the individual income of the policyholder. The policyholder can apply for health insurance if he falls under the Federal Poverty Line (FPL). The policyholder may qualify for the tax credit that may lower the monthly premium. The premium reduction depends on the income of the policyholder. The Marketplace will determine whether the policyholder qualifies for a tax credit, as well as the amount of the credit. Though some private insurance companies provide health insurance under the Marketplace, not everyone is eligible to avail the benefits of them. Those who do not fall under the Federal Poverty Line, have to look for insurance of the marketplace.
The Department of Banking and Insurance in the State of New Jersey has introduced the Individual Health Coverage Program. It was created to ensure that people without access to employer or government provided healthcare programs can buy health insurance from a private entity. Under the Individual Health Coverage Program, the policyholder is guaranteed renewable health coverage under a standard individual health benefit plan, regardless of the age and health status.
Insurance companies or individual agents providing health insurance are also called as network providers. All individual plans are either Exclusive Provider Organization or Health Maintenance Organization plans, and only cover services and supplies provided by network providers. Reviewing the network of plans to ensure that your doctor and the provider participate in the same network is necessary.
New Jersey Health Insurance plans
Cost Sharing refers to the amount you pay to use the services provided under the plan using a combination of copayments, deductibles, and coinsurance. Cost sharing depends on your need to visit your primary care provider, specialist, therapist, prescription drugs, and scheduled surgery. Focusing on the usual or the expected use of the services, one can estimate the out-of-pocket cost to be paid in addition to the monthly premium.
Maximum out-of-pocket (MOOP) refers to everything you pay as copayments, deductible and coinsurance during the year, added together. You do not have to pay any more copayments, deductible or coinsurance for the rest of the year once it reaches the MOOP amount for the plan selected. MOOP acts as a safety net for those who use a lot of health care services or expensive drugs.
Cost of health coverage
The total cost of coverage for health insurance is made up of the monthly premium paid, and out-of-pocket cost sharing paid for the services used. Premium is the fixed amount one must pay every month for the plan. It varies between different companies and plans. Premiums are to be paid irrespective of whether the service is used or not.
A policyholder has to analyze the cost associated with the plan before making the decision. If the estimate out-of-pocket plus annual premium exceeds or meets the Maximum Out Of Pocket plan, then adding MOOP to the annual premium is the best option. The best plan will be the one with the lowest total cost.