-- Health - Health Insurance & HMOs
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* History
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Health
* Status * Hospitals * Insurance/HMOs * Medical/Nursing schools * Consumer information * Economic impact * Health associations * Links * Health Images-Gallery -- Overview Health insurance in New Jersey is subject to regulation of the New Jersey Department of Banking and Insurance. The Department is authorized to review rates and to evaluate operations and performance of carriers licensed to offer coverage in the state. Under the federal Affordable Care Act (Obamacare), insurers planning to increase plan premiums by 10% or more are required to submit their proposed rates to either the state or federal government for review. Within the Department, its Health Insurance Bureau reviews individual and group health insurance contracts, including disability income, long term care, Medicare supplement, accident-only, hospital confinement indemnity, dental care and vision care health insurance contracts. In 2014, the Kaiser Family Foundation reported that 11% of New Jersey residents lacked health insurance coverage, a 3.29% decline since the federal Obamacare program went into effect and slightly under the national uninsured rate of 14.22%. Of those covered by insurance, 55% of New Jersey residents were covered under employer or other private group plans; 17% under Medicaid; 13% under Medicare; and 4% by non-group individual plans. Horizon Blue Cross and Blue Shield of New Jersey dominates the New Jersey health care insurance market, with over 750,000 enrollees and over 60% of total insureds. All other companies offering coverage in New Jersey have market shares below 10%. In 2015, the company's introduction of its new OMNIA line of health plans provoked litigation by several hospitals and other facilities claiming that they would lose substantial numbers of patients and revenue as a result of the two-tiered plans, which offer consumers lower deductibles and out-of-pocket costs if they use the medical professionals and hospitals selected by Horizon to be in the "tier 1" category. * Health Insurance Bureau, New Jersey Department of Banking and Insurance * State Health Facts, Kaiser Family Foundation * Data and Statistics, Centers for Medicare & Medicaid Services * Health Plan Report Cards, National Committee for Quality Assurance * State: We got it right by approving disputed N.J. Horizon hospital plans, NJ.com -- Managed care Insurers provide coverage through traditional indemnity plans, in which those covered submit bills to or are reimbursed by carriers for payments for health services, or through managed care programs in which those insured become members of health maintenance organizations or preferred provider organizations. As of July 2013, just over 2 million New Jersey residents were members of health maintenance organizations, the 9th highest number of all states. Under managed care, carriers seek to control costs and offer lower premiums through negotiating agreements with hospitals, physicians and other providers at lower rates in return for delivering the volume of patients enrolled as members in either the HMO or PPO. The payment system has been a major cause of consolidation within the healthcare industry as carriers with larger numbers of insureds and larger health systems seek to use their respective size as leverage in negotiating agreements. HMOs authorized to provide services in New Jersey in 2015 are: -- Medicare and Medicaid
As of 2015, there were just under 1.5 million New Jersey residents covered under the federal Medicare program. In 2012, spending per capita was $9,640, 7% above the level for the nation as a whole. The average age of Medicare enrollees in the state was 76 years old and 58% of those covered were female. The federal Medicaid program includes, as of September 2015, another 1.7 million residents in the state, including 795,000 children. Medicaid provides health insurance to parents/caretakers and dependent children, pregnant women, and people who are aged, blind or disabled. These programs pay for hospital services, doctor visits, prescriptions, nursing home care and other healthcare needs, depending on the program for which a person is eligible based on income and other requirements. The Medicaid program in New Jersey is administered by the Division of Medical Assistance & Health Services in the Department of Human Services. Most Medicaid beneficiaries are enrolled in managed care HMOs under NJ Family Care. Five health plans participate in the FamilyCare program:
* Division of Medical Assistance & Health Services, New Jersey Department of Human Services * Data and Statistics, Centers for Medicare & Medicaid Services * Health Plan Report Cards, National Committee for Quality Assurance * State Health Facts, Kaiser Family Foundation |
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