How much will you pay in NJ for ACA health insurance in 2024? We tested it out
As the days are set to get darker and holidays approach, there is one seasonal ritual that has already begun for hundreds of thousands of New Jerseyans: choosing a health care plan for 2024.
The open enrollment periods began Wednesday for Get Covered NJ, the state government's Affordable Care Act marketplace used by more than 340,000 New Jerseyans who do not get health insurance through an employer and are not eligible for Medicaid or Medicare.
Gov. Phil Murphy's administration has said "record levels" of government assistance are available for those signing up for 2024 due to millions in funding in the state budget along with the federal Inflation Reduction Act enacted last year.
No one is supposed to pay more than 8.5% of their income for a benchmark plan — a plan that the state designates as the standard for essential health benefits.
But how much in premiums are people really paying? And how good are the plans?
To find out, NorthJersey.com went to the Get Covered NJ website and typed in details for three theoretical insurance seekers from very different demographics, since premiums are based on several factors including age, income, how many people are covered by the plan, what type of coverage they want and more.
A single young person making $45K
We put in information for a theoretical 25-year-old with a $45,000 yearly income. Because younger people are often healthier, we chose a bare bones plan defined as "1-2 doctor visits and lab tests each year; preventive care too." Up popped 98 health plans, and all but a handful were marketplace plans.
The enrollee would receive $288 a month in savings, almost split between the state and federal government.
Premiums started at $70 per month for an exclusive provider organization plan, where a person must use the doctors and medical centers chosen by the plan. There are no out-of-network benefits. The plan had a $25 co-pay for office visits, generic drugs at 50% off the retail price, a deductible of $6,000 and an annual out-of-pocket maximum expense of $8,000.
The highest marketplace premium was $680 per month for another exclusive provider organization plan with a $30 co-pay for office visits, $10 for generic drugs, a $1,700 deductible and $7,000 out of pocket maximum.
A family of four making state median income
Next, we entered information for a family of four — two parents aged 40 and two kids aged 9 and 11.
The federal government put New Jersey's median income for a family of four in 2022 at $141,000. We chose a medium-level care plan, which is described as "3-5 doctor visits and lab tests with an x-ray each year; one or more small treatments done in doctor’s office; often, the care is for an ongoing health problem."
We had 92 health plans to choose from.
After an almost $718-a-month tax credit was applied, premiums ranged from $508 to $3,019 a month. The lower end was again an exclusive provider organization plan with a $25 co-pay for office visits, 50% off generic drugs, a $12,000 deductible and $16,000 out-of-pocket maximum. Other lower premium plans had the highest family out-of-pocket marketplace maximums allowed by law: $18,900
The most expensive marketplace plan cost $3,019 a month after the credits. Office visits required a $30 co-pay, generic drugs had a $10 co-pay, the deductible was $3,400 and the out-of-pocket max was $14,000.
Retired couple not yet eligible for Medicare
Next, we put information in for a couple of empty-nesters, each 63 and two years shy of being eligible for Medicare. Both have retired early and have started collecting reduced Social Security checks and income from retirement savings or a pension. We put their annual income at a combined $80,000.
More: What happens when an elderly relative can’t live alone? What to know about aging in NJ
We signed them up for a high-use plan defined as "6 or more doctor visits and a number of lab tests; a surgery, therapy or other treatment in an outpatient center plus follow-up care," since greater care is often needed as one ages.
This couple get the biggest chunk of government help with $1,691 a month, mostly from the federal level.
That helped offset the lowest premium to $459 a month for a plan that includes a $50 co-pay for office visits, $25 co-pay for generic drugs, a $4,700 deductible and $17,700 out-of-pocket maximum. The highest was a $1,915-a-month plan with $30 office visit co-pay, $25 co-pay for generic drugs, a $5,000 deductible and $18,900 max out-of-pocket.
How do I sign up?
Go to the new website, getcovered.nj.gov.
Residents enrolled in a health plan through Healthcare.gov will be automatically transitioned to Get Covered New Jersey.
When can I sign up?
Open enrollment for Get Covered NJ's 2024 coverage is much longer than most private plans. It runs from Nov. 1 to Jan. 31, 2024. But if New Jerseayns want coverage beginning right at the new year, they must enroll by Dec. 31. They must enroll by Jan. 31 for coverage to begin Feb. 1.
Those who experience certain life events like losing health insurance or the birth of a child are eligible to buy or change coverage outside the open enrollment period.
What companies are offering coverage?
United Healthcare
Aetna
AmeriHealth
Horizon Blue Cross Blue Shield of New Jersey
Oscar
Ambetter from WellCare of New Jersey
This article originally appeared on NorthJersey.com: What will you pay in NJ for Obamacare in 2024? We tested it out
