Obamacare enrollment begins Nov. 1: NJ residents should know these 3 things

Oct. 31--New Jerseyans heading into the Obamacare market to buy insurance for 2019 will find that despite all of the political and legal wrangling from the past year, the health care program is virtually unchanged.

In the Garden State, the individual mandate still looms, pre-existing conditions remain covered and health care networks are in tact.

The biggest difference? The average monthly cost for insurance is falling.

"There is at least better news that the increase isn't as much this year -- or even close to as much," said Toby Stark, a Tinton Falls health insurance broker and a former president of the New Jersey Association of Health Underwriters, a trade group.

Open enrollment for next year begins Thursday and lasts until Dec. 15, giving consumers who aren't covered by Medicare or their employer a chance to sign up for health insurance and apply for subsidies to offset the cost. Consumers can go to HealthCare.gov to enroll.

It comes after an eventful year that saw the administration of President Donald Trump take aim at some of the law's key provisions -- only to watch Gov. Phil Murphy and the New Jersey Democrats piece it together again.

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Watch a video at the top of this story about a poll showing a majority of survey respondents want Obamacare rules to stay in place.

Some 240,000 New Jerseyans were covered by Obamacare plans at the end of the first quarter, according to the state Department of Banking and Insurance.

That amounts to about 6 percent of the state's overall health insurance customers, according to Kaiser Family Foundation, a health care research group.

But the insurance program has helped reduce New Jersey's percentage of uninsured people from nearly 13 percent before the Affordable Care Act went into effect in 2010 to 8 percent in 2016.

Nationally, Obamacare remains under fire. The Trump administration and Congress stripped away the mandate requiring nearly all Americans have health insurance or pay a penalty.

It provided financial relief, particularly to healthy consumers who found insurance plans too expensive. But it also increased prices, since it meant healthy people could have dropped out of the market, leaving older, sicker consumers to pay for it.

Meantime, the Trump administration slashed funding for consumer advocacy groups that helped people sign up.

New Jersey lawmakers:

* Reinstated the individual mandate penalty for consumers who aren't insured. It is 2.5 percent of a household's income, or $695 per adult and $347.50 per child, whichever is higher.

* Worked with the Trump administration to create a reinsurance plan. The state will reimburse insurers for 60 percent of the claims of high-risk consumers.

* Funded an outreach plan. Murphy administration officials said the state would spend $375,000 to fund five organizations to help people navigate the enrollment process. (Scroll down to see which organizations are included.) It also plans to spend $450,000, largely on digital advertisements. And it created a website, GetCovered.NJ.gov, with more information.

It marked a departure from former Gov. Chris Christie, who accepted the Medicaid expansion, but opposed the rest of the Affordable Care Act and did not allow departments in state government to engage in public activities supportive of it.

Murphy said his steps have paid off. New Jersey consumers, who were in line to pay on average 12.6 percent more on premiums, are expected to see average premiums decline 9.3 percent, instead.

"Take it from New Jersey: when you uphold the principles of the Affordable Care Act, you end up with more affordable health care. Period," Murphy said Tuesday.

What should consumers look for?

1. Price

New Jersey has three insurers selling policies in the individual market. They are: AmeriHealth New Jersey, Horizon Blue Cross Blue Shield of New Jersey and Oscar, which offers plans in the state's 14 northern counties.

How much are they? AmeriHealth offers a silver plan for $267.25 a month. Horizon offers a silver plan for $322.71 a month. And Oscar offers a silver plan for $298.21 a month.

Then it gets complicated. The silver plan is designed to cover 70 percent of the cost. Some of them have high deductibles, meaning consumers could pay hundreds out of pocket before insurance kicks in. And older consumers can be charged more than their younger counterparts.

Also, consumers shopping in the marketplace still are eligible for subsidies if their income is less than four times the federal poverty rate -- $100,400 for a family of three.

"On average, our members will see about a 14 percent decrease," said Veronica Diaz, manager of sales enablement for AmeriHealth New Jersey. "That doesn't take the impact of the subsidy into account."

2. Network

Both Horizon and AmeriHealth feature tiered plans, giving consumers a discount for going to preferred health care providers. Hackensack Meridian Health and RWJBarnabas Health are in the top tier for both plans.

Horizon in particular faced an outcry. It is the state's biggest insurer. And it has about 60 percent of the individual market. But it recently settled a lawsuit from Tier 2 hospitals that said they were unfairly excluded from the top network, including CentraState Medical Center in Freehold Township.

It's a reminder that consumers should double check to make sure their doctors are in their insurance company's network.

"Clearly members have seen the value of those programs in terms of lower cost and greater value," said Michael Considine, a Horizon vice president, noting the company's premiums are down on average 7 percent this year.

3. Value

Both Horizon and AmeriHealth have been working more closely with providers for better care, in part by changing the way they are paid by rewarding them for the outcome of their care.

Oscar is banking on user-friendly technology that connects members with a concierge, who is based in Tempe, Arizona, and refers them to nearby doctors.

Its members are eight times more likely than the industry average to use telemedicine, said Louis DeStefano, vice president of sales at Oscar.

"New Jersey offers a tremendous opportunity for us," he said. "We're excited to grow and continue to grow. With the stability of the market, every carrier should be very satisfied."

Michael L. Diamond; @mdiamondapp; 732-643-4038; [email protected]

Need Obamacare help?

These organizations can help you sign up:

* Fulfill Monmouth & Ocean, of Neptune and Toms River

* The Center for Family Services, of Camden

* The Family Resource Network, of Hamilton (Mercer County)

* The Oranges ACA Navigator Project, of Orange

* The Urban League of Hudson County, of Jersey City

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