N.J.’s Obamacare enrollment could reach 250,000 in 2015

Tens of thousands more New Jerseyans could purchase 2015 government-subsidized health insurance policies during the three-month open enrollment that starts Saturday on HealthCare.gov — on top of about 160,000 who bought 2014 coverage in the first year of the “Obamacare” online health insurance exchange.Five health insurers will be on the exchange this time around, two more than in 2014, and experts are hoping the ramped-up competition and choice motivate plenty of consumers to buy health plans they want at prices they can afford — and thus continue 2014’s dramatic reduction in the number of uninsured in New Jersey.

UnitedHealthcare’s Oxford brand and Oscar Insurance are entering New Jersey’s HealthCare.gov market, joining the three current players: Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth New Jersey and Health Republic Insurance of New Jersey.

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Another 90,000 or so New Jerseyans could sign up for Obamacare coverage during open enrollment from Nov. 15 to Feb. 15, 2015, estimates Joel Cantor, director of the Rutgers Center for State Health Policy. He cautioned: “It’s hard to make firm predictions. But it seems reasonable to assume that by the end of the upcoming enrollment period we will reach 250,000 or so total enrollment — but it could be more or less.”

Cantor said that, between HealthCare.gov, where low- and moderate-income New Jerseyans buy government-subsidized coverage, and the state’s Medicaid expansion, New Jersey has made “a serious dent in the uninsured.” He said Medicaid enrollment rose nearly 30 percent, to 1.65 million in October, from 1.28 million at the end of 2013.

Ray Castro, senior policy analyst with New Jersey Policy Perspective, estimates that more than a half-million New Jerseyans have gotten covered, either through the exchange or Medicaid — cutting the number of uninsured in the state nearly in half, by one estimate: “Considering that (HealthCare.gov) has been open for less than a year, that is an incredible accomplishment that has exceeded expectations.”

Most who bought 2014 plans at HealthCare.gov chose industry veterans Horizon and AmeriHealth, with newcomer HRINJ signing up about 5,000 customers. Now all three face new competition from UnitedHealthcare’s Oxford, a well-established insurance brand throughout the state, and from the newcomer Oscar.

Horizon is launching a new, lower-premium “patient-centered” plan on the exchange for 2015. With both lower premiums and out-of-pocket cost, the plan incentivizes consumers to seek medical care from Horizon’s network of 3,700 patient-centered practices, the largest such network in the state. Patient-centered practices, which focus on the quality rather than quantity of care delivered, have begun to show success at both improving population health and lowering wasted spending, particularly by reducing hospital readmissions and ER visits.

Horizon spokesman Tom Rubino said the company has the largest individual insurance enrollment in the state, at 121,000, of whom 55,000 signed up via HealthCare.gov.

Horizon is offering nine plans on the exchange for 2015, up from five this year. Of the five existing plans, three will have premium increases in 2015 of less than 3 percent, and the other two will have decreases, Rubino said.

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The new patient-centered plan “is the biggest innovation” in Horizon’s 2015 exchange lineup, Rubino said.

“We are transforming the delivery of health care,” he said. “We are putting in the market products that will increase the number of people looking for patient-centered care.”

Ryan Petrizzi, vice president of consumer markets and sales operations for AmeriHealth, said the company now has about 115,000 individual customers, 80 percent of whom signed up on HealthCare.gov. Insurers sell the same plans on and off the exchange, but consumers have to shop at HealthCare.gov to get the subsidies.

Overall, AmeriHealth premiums will rise 11.5 percent in 2015, with 5.5 percent representing taxes and fees under the Affordable Care Act, and the rest mostly reflecting the ever-rising cost of health care, Petrizzi said.

“With more competitors, we’ll see overall tougher competition out there, which is better for the consumer in the end because there will be more choices for them,” Petrizzi said.

AmeriHealth is adding news plans and dropping a few, and on balance will offer 18 plans on the exchange in 2015, up from 14 this year.

One of its most successful plans, with more than 11,000 members, is co-branded with Cooper University Health Care and offers lower premiums to members who use the Cooper system.   AmeriHealth is adding two new hospitals, Cape Regional and Shore Medical Center, and expanding the product, renamed Community Advantage, from three to five southern New Jersey counties. New bronze and gold plans will augment the silver plan offered in 2014.

AmeriHealth has numerous plans and a variety of hospital and doctor networks, including a nationwide network. And the company offers “tiered” plans in which members have access to the AmeriHealth statewide network, but have lower out-of-pocket costs if they use a local network.

Consumers are saying “I am willing to pay a lower premium and see local doctors and get my care on a more local basis,” Petrizzi said.

Jim Martin, chief executive of HRINJ, has said the insurer’s slightly higher premiums put it at a competitive disadvantage this year, despite its extensive network of doctors and hospitals covering the entire state. For 2015, the company is lowering premiums between 10 and 20 percent and expanding to Delaware, eight counties in New York and nine counties in Pennsylvania.

“Having listened to our members over the past year, we’ve designed plans that offer some exciting features and attractive pricing,” he said.  For example, Monmouth County residents who use a local network of providers will have lower premiums, and in some plans will have a zero co-pay on generic drugs. The company also offers a new, cost-saving plan called Spotlight.

HRINJ members won’t need a referral to see a specialist in any of the company’s plans in 2015.

Chuck Cerniglia, vice president of UnitedHealthcare, said the company is offering plans under its Oxford brand at HealthCare.gov in which consumers “can choose from a range of six different health plans at varying premium rates to find the coverage that best meets their health care and budget needs.” He said the plans provide access to a network of 18,000 physicians and 65 hospitals across New Jersey.

Cerniglia said that, during open enrollment, customers who contact Oxford online or by phone will find that “We will have extra resources available to help consumers who are either new to buying health insurance or who would like to switch plans.”

RELATED: Half of Obamacare users don’t want to go back to the Exchange this year, survey says

Oscar Insurance is offering coverage in nine northern New Jersey counties as it enters the state for the first time in 2015, with plans to expand statewide in future years. Oscar said its price-competitive plans focus on consumer convenience. For example, Oscar will offer unlimited, free “tele-visits” — members can reach out to Oscar by phone or through the website and get a call back from a doctor within 10 minutes.

Mario Schlosser, co-chief executive, told NJBIZ, “We will simplify the complex health insurance process, we will guide you through the health care system and we will make you feel like you have a doctor in the family.”

Castro of New Jersey Policy Perspective predicted that open enrollment will be more of a challenge this time around: “Most of the people who were motivated to have insurance have already enrolled.”

For consumers, the big issue is affordability — and he said New Jerseyans still don’t realize that generous government subsidies are available for those who quality based on their income.

“Almost half of all New Jerseyans who received a subsidy paid less than $100 a month in premiums” in 2014, Castro said. The subsidies are on a sliding scale based on income, and phase out entirely at four times the federal poverty level, or about $46,600 for an individual and $95,400 for a family of four.

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute, predicted enrollment will increase: “Two more companies coming on will increase the amount of advertising and focus, if nothing else.” And while the addition of two more companies isn’t likely to decrease costs through greater competition, “it increases innovation, new product designs and new methods of engaging consumers.”

Schwimmer said consumers are likely to be confused by the multiplicity of plans on HealthCare.gov, and the differences among the “metallic” tiers — bronze, silver, gold and platinum — in which higher-priced plans cover a bigger share of the medical bills. She said consumers “are going to need a lot of personal hand-holding to figure out which plan and which metallic tier is bested suited to their situation.”

John Sarno is president of the Employer Association of New Jersey, which is holding meetings with employers around the state to encourage them to get their workers covered and spreading the word to employers through a new website, GetWorkersCovered.org. EANJ is among the “navigators” designated by the federal Department of Health and Human Services to help get the uninsured covered. The website was created through a collaboration between EANJ and the South Orange-based Community Health Law Project, which received a $350,000 federal navigator grant to help people sign up at HealthCare.gov or enroll in Medicaid.

Sarno said that, while it will be more challenging to sign people up for coverage in the second year of Obamacare, a diverse collection of community groups and navigators are working throughout the state during open enrollment “to ensure that hard to reach groups are reached.”

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