Residents of the Garden State have plenty of options when it comes to health care. According to a study by US News, New Jersey has the 12th best health care in the country. The ranking considers health care access, quality, and good public health.
Health insurance options in New Jersey
According to the New Jersey Department of Banking and Insurance, there are several ways for residents to get health insurance:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most New Jersey residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 57% | ||
| Individual or family | 6% | ||
| Medicaid | 17% | ||
| Medicare | 13% | ||
| Uninsured | 7% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Seven percent of New Jersey residents are uninsured. This percentage falls below the national average, which bodes well for policyholders. The more uninsured people in the state, the higher rates tend to be for insured people.
New Jersey health insurance costs and rate factors
New Jersey residents spend an average of $8,859 per year on health care expenditures. That's a few hundred more than the national average. So, what determines your insurance price tag in New Jersey? Rate factors vary from person to person, but here's what your provider will be looking at to price your policy:
Body mass index
According to the CDC, a high BMI makes you more likely to suffer from serious diseases and health conditions. Insurers look at this when pricing your policy to determine your risk-level. A high BMI often results in higher insurance rates.
In 2017, New Jersey had a 27.3 percent obesity rate, the 41st highest rate in the country. An average of 26 percent of New Jersey residents who used QuoteWizard to compare health insurance rates have a BMI in the obese range.
Tobacco use
Smoking takes a huge toll to your health, and insurers know it. Providers charge tobacco users more for health insurance. About 13.7 percent of New Jersey residents smoke, the sixth lowest rate in the country.
Age
Older people tend to pay up to three times more than younger people for health insurance plans. New Jersey residents who shopped for health insurance using QuoteWizard are, on average, 41 years old.
Plan type
The more medical coverage you want, the more you'll have to pay in monthly premiums. Marketplace plans are organized into metal categories: bronze, silver, gold, and platinum.
How much should you expect to pay for health care in New Jersey? These are the average monthly premiums for a 40-year-old Garden State resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $314 | $382 | $657 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
In New Jersey, premiums for a gold plan are more than double the cost of a bronze plan. The price spike is because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent.
If you're under 30 or have certain exemptions, you may qualify for a catastrophic plan. These plans have low monthly premiums but a $8,150 yearly deductible. You'll have to pay more monthly, but a bronze or silver plan may save you money when you need to use your health insurance.
Location
Every state handles their health care marketplace differently. New Jersey has unique laws, regulations, and providers surrounding health insurance. Because of this, your location is a big factor in how much you'll be paying for health insurance.
Health care costs can also be community rated. So, your prices may depend on the combined claims that everyone files. If your neighbor files a high rate of insurance claims, your prices could be higher.
That means that living in a health-conscious state could keep your premiums low. America's Health Rankings put New Jersey as the 12th healthiest state in the country.
New Jersey health insurance companies
New Jersey has one of the best health care rankings in the country, but only a few provider options for individual and family plans. Here are the Garden State's health insurance company options:
- AmeriHealth
- Horizon BlueCross BlueShield of New Jersey
- Oscar
Some of these companies only offer policies in certain counties. Check the employer site to find out if coverage applies to your zip code.
New Jersey health insurance laws
The Affordable Care Act ensures that insurance companies can't consider certain factors when pricing your policy.
- Pre-existing conditions: According to HHS.gov, providers can't charge you more for pre-existing conditions. People with pre-existing conditions used to pay a lot more for insurance, if they were able to get coverage in the first place.
- Gender: According to a study that looked at gender and health care costs, women historically pay more for health insurance. The ACA mandates that insurance companies can't charge women and men different prices for the same plan.
- Insurance and medical history: Insurance companies also used to analyze your past insurance coverage and medical history. Any sign of a medical issue or lapse in coverage would raise prices.
According to HealthCare.gov, marketplace plans have out-of-pocket maximum limits. The 2020 out-of-pocket maximum is $8,150 for individual plans and $16,300 for family plans.
New Jersey law requires health insurance companies to provide at least some coverage for the following services:
- Infertility treatment
- Cancer screenings
- Hearing aids for people under 15
- Diabetes treatment
- Cancer treatments
- Infant formulas
- Maternity care
There are more health care services that providers need to offer. Find the complete list here.
Medicare and Medicaid in New Jersey
Medicare and Medicaid are both government-funded health care programs. These programs offer affordable coverage for different groups of people. Medicare is available to seniors, and Medicaid helps low income families and children.
Medicare
People 65 and older are eligible for Medicare. There are several coverage options, including parts A, B, C, D, and supplemental coverage plans. As a New Jersey resident, you may be eligible for a Medicare Savings Program with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid is available to low income families and children. Here are the state's Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
New Jersey Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Marlene Caride
- Insurance Hotline:
- (800) 446– 7467
- Office Hours:
- Monday - Friday
8:30 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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