NJ residents expected to pay less for health coverage through new state-run portal

A new state-run marketplace for New Jersey residents who buy their own health insurance — getcovered.nj.gov — goes live today, and many consumers are expected to pay less for coverage than in previous years.

A combination of new state subsidies and low premium increases by health insurers will drive the average cost for those eligible for assistance to its lowest level since the Affordable Care Act was enacted, state officials said. Average monthly premiums, when credits and subsidies are included, will be $117. 

The new website, operated by the state Department of Banking and Insurance, replaces the federal marketplace, Healthcare.gov. The open enrollment period — from Nov. 1 through Jan. 31 — will be twice as long as it has been in recent years, and the state is spending $3.5 million, more than three times as much as it did last year, on outreach and enrollment help.

"The coronavirus pandemic has underscored the need for all residents to have health coverage," Gov. Phil Murphy said. “We are proud of the steps we have taken to support the Affordable Care Act and push back against attacks on the landmark law by the Trump administration. Our policies improve affordability and access to coverage at a critical time."  

In addition to establishing a new, state-run insurance marketplace, the state enacted other laws to replace parts of the Affordable Care Act that have been rolled back or challenged by Republicans and the Trump administration:

• Insurers in New Jersey are banned from excluding coverage of preexisting health conditions and using factors other than age to set premiums.
• All state residents, with limited exceptions, are required to have health coverage or pay a penalty. 
• Plans sold on getcovered.nj.gov must cover the 10 essential health benefits required under federal law, including preventive services, emergency services, prescription drugs, and prenatal and pediatric care. 

A challenge pending before the U.S. Supreme Court could upend the federal law, jeopardizing gains in insurance coverage and changes in the health care system in the United States. Oral arguments are scheduled for Nov. 10.

Democrats fear that the appointment of Judge Amy Coney Barrett to the court would make it likely that the decision would partially or completely overturn the law. But some legal experts say the decision could be more limited in scope.

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In New Jersey, some 218,000 people have coverage through the Affordable Care Act, and about 80% receive financial assistance. Another 600,000 have gained coverage through NJ Family Care, the free or low-cost Medicaid program that was expanded with federal funding. 

Next year, three insurers will offer coverage on getcovered.nj.gov — Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth New Jersey and Oscar Health Insurance. As in previous years, different levels of coverage — bronze, silver and gold — are available. 

People who don't require financial assistance have one more company — Oxford Health Plans — and many additional health plans from which to choose. While they may go through the marketplace, they can also purchase coverage directly from insurers.  

The average premium for 2021, when federal tax credits and new state subsidies are included, will drop to $117 monthly, compared with $164 monthly last year and $148 monthly in 2014, state officials said. State subsidies will average at least $578 for an individual and $2,313 for a family of four.

To be eligible for financial assistance, consumers must have incomes below $51,040 for an individual or $104,800 for a family of four. Only those who shop on the state marketplace will be able to get financial assistance in 2021.

Without subsidies, the average rate hike was 3.3%. That includes increases of 10.4% for Oxford, 6.5% for AmeriHealth, 6.1% for Oscar, and 1.1% for Horizon.

Health insurers profited from the cancellation of elective surgeries and other procedures this year due to the pandemic. It's unclear whether pent-up demand will drive costs higher next year. New Jersey law requires insurers to spend 80 cents of every premium dollar on medical expenses, with rebates to customers if expenditures fall below that. 

The state has sent letters to those who purchased this year's coverage through healthcare.gov. They will be automatically transitioned to getcovered.nj.gov. 

People can start comparison-shopping now for health plans and learn how much financial assistance they are eligible for. They can also find out if they qualify for Medicaid.  

Policies can be purchased starting Nov. 1, and must be bought by Dec. 31 for coverage beginning on Jan. 1. The open enrollment period will continue through January. Those eligible for Medicaid can enroll at any time. 

Lindy Washburn is a senior health care reporter for NorthJersey.com. To keep up-to-date about how changes in the medical world affect the health of you and your family, please subscribe or activate your digital account today.

Email: washburn@northjersey.com

Twitter: @lindywa