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New Jersey Health Insurance

Your search for New Jersey health insurance is going to require a bit of research to truly understand your options and make the best choice.  Luckily for you, the state of New Jersey has information on their NJ State Website to assist health insurance buyers in certain tricky situations.

Also, information on this web page can help walk you through the process of finding the best health insurance company in NJ quickly and easily.

First you must understand which type of health insurance you qualify for and need. Then feel free to use the search tools above to find a company that can provide it to you for the best price.

                        New Jersey Health Insurance Introduction

The first step in finding a health insurance company is to understand the different types of insurance that are available to you.  They are broken down into four different components:

  1. Group - Employer Sponsored:  This insurance is the most common and typically, the lowest premium out of your pocket.  Your employer takes on the insurance costs and will usually pay part, if not all, of the insurance premium.

  2. Group - Association Sponsored:  Usually a professional organization will offer its members a discounted premium through a certain insurance company.  For those that are self-employed or employers don’t offer an insurance plan, this is a great option.

  3. Individual:  This is when you are purchasing the insurance directly from the insurance company.  This is often a great options for healthy individuals who don’t want to cover the costs of high risk members of group plans.

  4. Government:  This covers senior citizens, individuals injured from the Military, economically disadvantaged and disabled.  The state of New Jersey offers a program called SHIP (State Health Insurance Assistance Program) that is available to help NJ Medicare beneficiaries with questions or problems they are having with their insurance.  Call 1-800-792-8820 or visit the New Jersey Department of Insurance for further details.

New Jersey Health Insurance Plans

The NJ health plans differentiate in price and in availability/freedom of choosing a physician.  The two main categories are traditional and managed care plans.  A traditional plan, or often called an indemnity plan, is the original platform for insurance.  A traditional plan has the following distinctions:

  • Freedom in choosing a physician or hospital to receive treatment.  There are no restrictions, no referrals, and no in-network list of providers.

  • Often times you may be required to pay for your services in full, and then get reimbursed by the insurance company at a later time.

  • There is usually a deductible to be met first, and then co-payments corresponding with each treatment.

The managed care plans are as follows:

  • Health Maintenance Organization (HMO):  The intention of this plan was to cut rising health care costs when it originated in the 1960’s.  It does so by having a monthly set fee and little to no coinsurance.  You are assigned a primary care physician, commonly referred to as a PCP, and this doctor is in charge of all your general care.  However, if you need to see a specialist, you must first get a referral from your PCP.  If one is not obtained prior to service, your charges will most likely not be covered.

  • Preferred Provider Organization (PPO):  This plan was originated to speed up the process of payments to the providers from the insurance companies.  The providers chosen are called “in-network providers” and have agreed to the negotiated rates given by the insurance companies for certain charges.  For the members of the plan, they have more freedom in which doctors or facilities they choose.  Additionally they have lower coinsurance by staying within the network of providers.

  • Point of Service:  This combines aspects from both of the above mentioned plans.  The members of this operate under the HMO mentality with an assigned PCP as well as a monthly set fee.  However, at the time of service they may choose to see another physician and thus pay higher coinsurance for their services.  However, it will be covered on this plan whereas on the HMO it would not be covered.

These are the broad types of plans you can choose, but there are still other aspects to keep in mind for your specific policy.  Consider the deductible you can afford, the co-payments you will have to pay with each visit, and what other supplemental insurance you will need to purchase (dental, maternity, accident, disability, etc.).

Affordable New Jersey Health Insurance Options

The NJ FamilyCare program is designed to provide health insurance coverage for minimal or no cost to children and low income parents. Children must be 18 and younger to be eligible for coverage and parents must make below 133% of the Federal poverty level to be eligible for coverage.

Finding New Jersey Health Insurance For Pre-Existing Conditions

It can be difficult to find a New Jersey health insurance plan when one has major pre-existing health conditions. The reason that it is quite easy to find a cheap NJ health insurance plan if one is healthy is because individual health insurance in NJ can sometimes have a strict underwriting process that will only give cheap rates to those who are healthy. However, there are some things that you can do to find an affordable NJ health plan even with pre-existing health conditions.

The most important thing that you can do if you or a family member has a major pre-existing condition (such as cancer, asthma, diabetes, heart disease, etc.) is to make sure that you always maintain continuous coverage. Never let you coverage lapse.

The reason that this is so important is because there are laws in place that are designed to protect your right to have access to a health insurance plan in NJ as long as you do your best to maintain continuous coverage. Be sure and ask your NJ health insurance agent about the guaranteed issue New Jersey HIPAA health insurance plan (and also the parallel NJ COBRA health insurance requirements) to see if you may be eligible for this plan that covers all pre-existing conditions.

New Jersey Health Insurance Companies

Some of the medical insurance carriers offering New Jersey health insurance coverage include:


AmeriHealth New Jersey HMO

Horizon Blue Cross Blue Shield of New Jersey

Oxford Health Plans of New Jersey


United Healthcare

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