Picking the Best ACA Health Insurance Plan in New Jersey for 2023
The Affordable Care Act (ACA), also known as Obamacare, is a piece of legislation designed to provide affordable healthcare to all Americans. There are several different types of ACA health plans, and it is important to understand how these plans vary. The best ACA plan for you is based on your income level, household size, and healthcare needs.
What are the best plans on New Jersey’s exchange?
The ACA offers several types of health plans grouped into different categories. The following article will delve into how these plans are organized and which is most suitable for your needs.
Metal Tier Plans
The ACA organizes plans into 4 metal levels: Bronze, Silver, Gold, and Platinum. Each level varies in terms of premium and deductible cost. Still, the quality of care remains the same throughout each level. These metal tiers determine the cost-sharing between you and your insurance provider.
Here is a brief overview of each of the 4 metal levels:
- Bronze: Best for Young and Healthy People
- Silver: Best for Individuals with Low-Income
- Gold: Best for Comprehensive Coverage
- Platinum: Best for Frequent Medical Needs
Cost-Sharing of Metal Tier Plans
|Metal Level||Insurance Pays||You Pay (Deductible)||Monthly premium|
List of Available Plans on New Jersey’s ACA Exchange
The following table lists all the available plans from New Jersey’s ACA exchange in 2023. They are generally ordered from lowest premium and highest deductible to highest premium and lowest deductible. Additionally, they are sorted based on metal tier, starting with Bronze and ending with Gold. Each type of tier plan is more well suited for a specific individual and their specific healthcare needs.
Plan (carrier + name)
|Bronze HSA EPO: Aetna Whole Health network (MinuteClinic + CVS Health Virtual Care) HDHP||$146.98/month||$6,000|
|IHC Bronze EPO HSA AmeriHealth Advantage $25/$50||$157.03/month||$6,000|
|Bronze: Aetna Whole Health network ($0 MinuteClinic + $0 CVS Health Virtual Care)||$160.45/month||$3,000|
|IHC Bronze EPO HSA AmeriHealth Hospital Advantage $50/$75||$175.86/month||$6,000|
|Oscar Bronze Classic ($0 Virtual Care) EPO||$202.80/month||$3,000|
|Ambetter from WellCare of New Jersey Bronze EPO||$205.85/month||$3,000|
|IHC Bronze EPO HSA Local Value 50%/50%||$208.12/month||$6,000|
|Horizon Bronze OMNIA EPO||$210.74/month||$3,000|
|Silver 1: Aetna Whole Health network ($0 MinuteClinic + $0 CVS Health Virtual Care)||$214.43/month||$2,350|
|Silver 2: Aetna Whole Health network ($0 MinuteClinic + $0 CVS Health Virtual Care)||$220.56/month||$2,500|
|IHC Silver EPO AmeriHealth Advantage $25/$60||$234.91/month||$2,500|
|Oscar Silver Simple - PCP Saver ($0 Virtual Care)||$230.04/month||$2,500|
|IHC Silver EPO AmeriHealth Advantage $45/40%||$233.13/month||$2,400|
|Ambetter from WellCare of New Jersey Silver 1007||$245.07/month||$2,500|
|Horizon OMNIA Silver Value EPO||$235.33/month||$2,000|
|Oscar Silver Classic ($0 Virtual Care) EPO||$253.50/month||$2,500|
|Oscar Silver Classic - $0 Ded ($0 Virtual Care) EPO||$271.41/month||$9,100|
|Oscar Silver Simple ($0 Virtual Care)||$233.33/month||$2,500|
|IHC Silver EPO AmeriHealth Hospital Advantage $50/$75||$261.44/month||$2,500|
|Ambetter from WellCare of New Jersey Silver EPO||$238.23/month||$2,500|
|Oscar Gold Classic - PCP Saver ($0 Virtual Care)||$425.09/month||$1,750|
|Ambetter from WellCare of New Jersey Gold 1009 EPO||$432.56/month||$1,750|
|Gold: Aetna Whole Health network ($0 MinuteClinic + $0 CVS Health Virtual Care)||$460.46/month||$1,500|
What should I consider when picking a health plan?
Before choosing a health plan, it is fundamental that you consider several factors. The healthcare plans in New Jersey on the ACA exchange are organized by metal tier. Based on your health needs, your financial situation, how much you can afford, and how often you travel, you can choose the most suitable plan. The following chart shows the average premiums in New Jersey for each metal tier.
Metal Tier Plans Prices and Recommendations
|Metal Plan||Average Price||Best Plan For|
|Bronze||$349||Best for Young and Healthy People|
|Silver||$400||Best for Individuals with Low-Income|
|Gold||$610||Best for People who need Comprehensive Coverage|
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Your health needs
Your health needs are critical when picking a health plan. People who require frequent or comprehensive medical attention or coverage should select from higher tiers. However, these tiers have a more expensive premium, and more of your coverage will end up being covered due to their lower deductible.
Here is a brief overview of each of the 4 metal levels based on your health needs.
- Bronze: Best for Young and Healthy People
- Silver: Best for Individuals with Low-Moderate Health Needs
- Gold: Best for Comprehensive Coverage
- Platinum: Best for Frequent Medical Needs
Your financial situation (how much you can pay out of pocket)
Choosing a healthcare plan depends on your financial situation or how much you can afford to pay out of pocket for healthcare. For instance, although the Bronze tier has the lowest average premium, it also has the highest deductible. You will have to pay for your healthcare needs out of pocket until you reach that deductible. As such, these plans are generally better suited for individuals who require infrequent medical attention. On the other hand, a gold plan has a much higher premium but a lower deductible. These plans are most well suited for people requiring frequent and comprehensive medical coverage as most of their healthcare will likely be covered for the year.
How much you can afford
Understanding your financial situation is essential before choosing a healthcare plan. If you find that the plans on the exchange are not affordable, you might qualify for a state subsidy for New Jersey. This subsidy is new legislation called New Jersey Health Savings (NJHPS) that can help you save on health insurance. NJHPS can decrease the cost of premiums for low-income individuals.
You can check to see if you or your family qualify for NJHPS by using the Shop and Compare Tool on GetCovered.NJ.gov. Generally, individuals with an income of up to $81,540 or a family of four with a combined income under $166,500 may be eligible for state subsidies.
If you travel frequently
If you find that you travel frequently, it is important that you are fully covered. If you are traveling outside of the U.S., you might have to pay out-of-pocket for their services. Some health insurance plans will cover emergencies that can occur out of the U.S.; check your plan to see if these activities are covered.
If you are traveling within the U.S., you might consider getting a PPO plan. A PPO plan might be more pricey, but it will give you the most access to out-of-network coverage. The following chart breaks down the differences between the plans you can choose from.
|Type of Plan||Network flexibility?||Cost?||Primary care physician?||Referrals for specialists?|
|HMOs:||Must stay in-network, except for emergencies||$||Required||Yes|
|EPOs:||Must stay in-network, except for emergencies||$$||Required||No|
|PPOs:||Out-of-network options are available, but more costly||$$$$||Not required||No|
|POS:||Out-of-network options are available but more costly||$$$||Required||Yes|
What happens if you can’t afford any plan on the exchange?
New Jersey is one of the states that impose a federal penalty if you are uninsured. Based on your household size and income, New Jersey will financially penalize you if you are uninsured or do not qualify for an exemption.
For an individual in the 2023 tax year, the minimum penalty is $695, and the maximum is $3,661. For a family with two adults and three dependents and a household income of $200,000 or below, the minimum penalty is $2,351. The maximum is $4,869. The penalty amount will be calculated and entered on your Income Tax form.
Catastrophic plans are not generally grouped with the other four metal plans. Still, they are a low-cost option for uninsured individuals. Although you can purchase a catastrophic plan under Obamacare, these plans can also be purchased directly from an insurance company without the official ACA exchange. These plans are similar to Bronze plans in that they have the lowest premiums and the highest deductible price. Like Bronze Plans, catastrophic plans cater to young and healthy individuals who do not expect to have high medical costs.
However, it is important to note that to be eligible for a catastrophic plan, you must meet either of the following criteria:
- Under age 30
- Any age but with a hardship exemption (given to individuals who cannot afford typical health insurance due to personal or financial circumstances).
Federal Financial Help
You can also receive financial assistance federally. For instance, you might qualify to have:
- Premium Tax Credit (PTC): a refundable tax credit that helps low-moderate income families and individuals afford their health insurance premiums.
- Cost-Sharing Reduction (CSR): a government-provided discount to help reduce out-of-pocket costs for low-moderate income families and individuals. CSRs will help to decrease your deductible, co-pay, or co-insurance fees.
Or, you might be qualified for federally funded insurance programs:
- Medicaid: insurance program for low-income individuals under the age of 65.
- Medicare: insurance program for people 65 and older, people with disabilities, or people with end-stage kidney disease requiring dialysis or transplant.
- Children’s Health Insurance Program (CHIP): for uninsured children under the age of 19
- Veterans Health Administration (VHA): medical services for American Veterans who have served for 24 uninterrupted months.
- TRICARE: insurance program for military families
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How to enroll in a New Jersey ACA plan?
Enrolling in an ACA plan can be a confusing process. For New Jersey specifically, individuals have to use a specific Healthcare Marketplace website that differs from the federal portal. The website that New Jersey uses is called GetCoveredNJ. This website contains all the information needed to enroll in an ACA health plan properly. We have a detailed article about how to enroll in an ACA health plan in New Jersey that you can visit here.
Here is a summary of how to apply for ACA health coverage in New Jersey:
- Sign up for an account and start an application on the GetCoveredNJ portal
- Use the “Shop and Compare” tool to view different plan options based on your income, household size, and personal preferences.
- Choose a plan and enroll by paying your first premium.
New Jersey ACA Health Exchange Frequently Asked Questions (FAQs)
Understanding how to choose the best plan for you or your family is difficult. It is necessary that you carefully examine your possible options and the type of coverage you want to receive. The following questions can help you understand how Obamacare works and whether or not you are eligible.
What is the difference between Medicaid/Medicare and Obamacare?
Medicaid and Medicare are both federally funded insurance programs. Medicaid is an insurance program for low-income individuals under the age of 65. Medicare is an insurance program for people 65 and older, people with disabilities, or people with end-stage kidney disease requiring dialysis or transplant. On the other hand, Obamacare is legislation that regulates private insurance company pricing and coverage. A U.S citizen needs to meet the requirements set by the federal government to qualify for Medicaid or Medicare. In contrast, any U.S citizen can buy private health insurance through Obamacare.
Do I qualify for Obamacare?
People of all incomes qualify for Obamacare unless they meet the following criteria:
- Your employer offers comprehensive and affordable coverage.
- You have access to coverage via a family member’s employer health insurance plan.
- You are eligible for federally funded health insurance such as Medicaid or Medicare.
- Your income is less than 100% of the federal poverty level.
- Your income is 400% above the federal poverty level.
- You are incarcerated.
What benefits are covered by ACA health plans?
The ACA requires that all health insurance plans include 10 essential health benefits. These 10 services must be covered in every state, but the extent of coverage may vary from state to state. These benefits are as follows:
- Ambulatory patient services
- Emergency services
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Ultimately, choosing a healthcare plan can be very stressful and challenging. However, as long as you understand the different options offered by New Jersey, and have properly considered your financial situation and healthcare needs, then you are more than well-prepared to choose a healthcare plan.
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Sophie is a 2024 Pharm D. candidate studying pharmacy at Rutgers University, New Brunswick. She has a passion for healthcare and writing and hopes to make meaningful contributions to healthcare transparency and accessibility. In her free time, she likes to take care of her houseplants, cook, and hang out with her cat.