How are insurance regulations different in NJ than other states?
Actually some regulations make it a little easier to find a policy here than in some other states. In Texas, for instance, private insurers are allowed to individually underwrite applicants. They can rate up and deny coverage based upon prior and current health status. But in New Jersey, private insurers are not allowed to deny coverage based upon health. This means that people with current health issues, even serious ones, can get a health plan today.
All New Jersey insurers must offer 5 standard plans to all consumers, regardless of health history. This requirement is unique.
Insurers are allowed to raise premiums based upon the age of the insured person, but even this is strictly regulated. Otherwise, ratings may be applied by gender and location. So in large part, New Jersey health insurance is community rated. If you are used to the insurance market in another state, this may be very different!
Preexisting Condition Requirements in NJ – There is a 6-month look-back and a 12-month exclusionary period limit for preexisting conditions in New Jersey’s individual health insurance market. So the news is not all good. If you have a health condition now, or have gotten treatment in the last 6 months, you may have to wait 12 months until you can get treatment covered under private insurance. Previous coverage rules may help shorten this.
This is all according to the National Association of Health Underwriters (NAHU) website. They keep a current listing of the state health insurance rules and regulations.
Major medical plans without individual underwriting in NJ, does not always mean that health plans are cheaper. Insurers will provide many different levels of coverage, from basic medical plans to comprehensive ones. You will have to select coverage based upon your own needs and budget.
Sometimes you can cut out certain benefits, that do not save you that much anyway, in order to lower monthly premiums. A doctor’s office visit copay plan may cost 25{421b746ef4f4588dfd87c8acf16c9c4b10a4a0127eaff1927a04f4091b6d6d60} more than a plan that does not include one. If your family rarely visits the doctor, you may save thousands of dollars a year by skipping this option.
Most major medical plans offer discounted network fees anyway. Consider a doctor who normally charges $100 for an office visit. You may have a plan that lets you visit the doctor for $40 each time. That seems like a big savings.
But it is very common for network medical providers to offer discounts to insured people. These discounts often range from forty to sixty percent. So that $100 bill may have only been $60 with a 40{421b746ef4f4588dfd87c8acf16c9c4b10a4a0127eaff1927a04f4091b6d6d60} discount! Now you are only saving $20 a visit. If you are paying an extra $100 a month for this benefit, it may not really be saving you any money at all.
What if you Cannot Afford New Jersey Health Insurance?
There are some active plans to help people afford their premiums. Medicaid provides coverage to very low income people. The state children’s health insurance plan helps families with moderate incomes. The children’s health insurance plan in New Jersey also provides coverage for pregnant mothers.
Beyond those state and federal health plans, many counties have a sliding scale health plan for lower income people.
Find the Right NJ Health Insurance For You!
Online health insurance quote forms make it easy for consumers to compare plans. Online quotes and qualified local agents are a few clicks away!