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New Jersey Health Insurance

Finding health insurance in the state of New Jersey is in many ways different than finding insurance in other states. New Jersey is a "guaranteed issue state" meaning that medical underwriting is not allowed on the individual market there. In other words, unlike in most other states, when you apply for an individual plan in New Jersey, you cannot be denied or excluded based on previous medical conditions, with some exceptions. Health Plan One can assist with any questions you may have about individual plans. Start by entering your zip code into the quote engine above to view plans available in your area. If you own your own business, Health Plan One can also assist small business owners in obtaining small group coverage for your growing company. If you have serious medical issues or don't think you can afford private health insurance in New Jersey you could qualify you for free or low-cost health care programs offered by the government, such as Medicaid or S-CHIP. Eligibility requirements for each of these options are available on this page.

What Every New Jersey Resident Should Know About Health Insurance

The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer, the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not medically underwritten, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you. Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits.

What If I'm Between Jobs?

It is important not to have a break in coverage of more than 31 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important. As a result, if you've recently lost your job, look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government, you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs to invest in an individual/family insurance policy through Health Plan One. With individual coverage, you choose the health insurance carrier and benefits you want with the help of Health Plan One. We will quote plans for you and your family from all the different carriers available in New Jersey so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. However, there are some special circumstances in the state of New Jersey you should be aware of.

What's Unique about New Jersey?

Insurance in the state of New Jersey is one of the most expensive in the country because medical underwriting is not allowed even on the individual market. Because insurance companies are not allowed to adjust prices on most products for age, gender, smoking habits, and health status, prices tend to be very expensive even for the young and healthy.

The first option you should look into when trying to get health insurance in New Jersey is whether you qualify for a small group plan. Small group plans are for people who own and operate a small business. These small group plans require a minimum of 2 employees in the group. Small group insurance is typically more affordable with richer benefits because there is an ability to adjust the price of the health plan by age and gender. In order to apply for such plans, you must be able to prove that you are in fact a small group by either having evidence of payroll for the employees or getting a letter from a CPA firm attesting to the fact that you have an employer group. Find further information about small group in New Jersey here: http://www.state.nj.us/dobi/division_insurance/ihcseh/sehmain.htm To get free quotes and more information on small group plans for your small-business, simply call Health Plan One at (877) 567-5267.

For more information on small group plans for this state please see our New Jersey Small Group page.

For individual and family health insurance, plans range in price from $400 to $2000 per month for an individual. The only plans that are more reasonably priced are the “Basic and Essential” plans. These plans were developed about 15 years ago by the legislature, which decided health insurance was too expensive for individuals in New Jersey. They directed the Department of Insurance and the insurance companies to develop plans that had a lot less benefits and were age and gender rated. So for the young and healthy, these may be a better purchase. However, before buying a Basic and Essential plan, please carefully note the benefits that are excluded from these plans. Many of these plans limit physician visits, exclude chemotherapy and mental health, and have little or no pharmacy benefit. These plans can be cost effective if you don't need these services, however you do take a risk that you become sick and require these services. Basic and Essential plans are creditable coverage but some people will change plans to a richer plan if they decide they need those benefits. You can change plans within the company at your anniversary date, however off-anniversary you would need to change companies.

In terms of the regular health plans, there are three carriers in New Jersey: AmeriHealth, Oxford and Horizon. Aetna and Health Net do have products but they're much more expensive than their competitors because they don't want to sell individual products in New Jersey but are mandated to by the state. To comply with this mandate they offer their products but at a very uncompetitive price. The Oxford PPO plans tend to be the most popular they are priced well, but it is because you can only access the Oxford-Liberty network, which is a subset of their normal network. So if you do decide to purchase the Liberty plan please make sure your physicians are in the network. For quotes on individual and small group plans in New Jersey, simply enter your information above to view quotes for free. Find more information about how individual insurance in New Jersey is different here: http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcmain.htm

There is no short-term health insurance available in New Jersey, because short-term health insurance is a medically underwritten product which is not permitted in the state.

If you're healthy and are between jobs, unhappy with the health insurance offered by your employer, or not offered benefits by your company, enter your zip code into the Health Plan One quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat (see the button to the right) or toll-free at (877) 567-5267 to answer any questions.

If you're not healthy, there are still many programs in New Jersey available to you. See below for details on the options which best fit your medical and financial situation.

Medicaid and Medicare in New Jersey

Medicaid is a federal-state cooperative created by Congress to finance health services for the nation's poor. The program pays for hospital, doctor, prescriptions, nursing home and other needs. For a full list of benefits, click here: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/needs/index.html The NJ Medicaid program currently serves the health care needs of more than 1 million New Jersey residents. Those who qualify for full-benefits under the program must fall into one of the following categories: families with children up to age 18, people who are aged/blind/permanently disabled, pregnant women, children. To be eligible for Medicaid, you must be a resident of New Jersey, a US citizen or qualified alien, and meet some income requirements. These income requirements can be found here: http://www.hrsa.gov/reimbursement/states/new-jersey-eligibility.htm For information regarding the special circumstances which qualify someone for partially Medicaid benefits see this page: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/

Click for information about and to view New Jersey Medicare Advantage plans.

S-CHIP

The State Children's Health Insurance Program (S-CHIP) is a program meant to cover those children whose families cannot afford private health insurance but also are not poor enough to qualify for regular Medicaid. These income requirements can be found here: http://www.hrsa.gov/reimbursement/states/new-jersey-eligibility.htm The program provides most of the same benefits one would receive with Medicaid, including doctor visits, hospital stays, prescriptions, and other services. In New Jersey this program is referred to as NJ Family Care, and can be researched here: http://www.state.nj.us/humanservices/dmahs/clients/njfamilycare/index.html.

For a full list of disability assistance programs go here: http://www.state.nj.us/humanservices/clients/disability/

For a full list of health care services available in New Jersey, see this page: http://www.state.nj.us/humanservices/clients/healthcare/

There is no high risk pool available to residents of New Jersey.