In New Jersey all residents are required to have health care coverage, and for 2021 the state is transitioning to a state-based exchange, Get Covered New Jersey. Consumer open enrollment runs through Sunday, January 31, 2021. Consider these seven tips when shopping for health care coverage this year.
Each year we all make a very important purchase. The process can feel overwhelming and that’s because the outcome directly impacts what we treasure most ― our families.
Selecting a health insurance plan shouldn’t be taken lightly, but it doesn’t have to feel daunting either. Research shows that 80 percent of women make health care purchasing decisions for their families. As a mother of two, I fall within this category and have learned some helpful tips throughout my nearly 30-year career in the New Jersey insurance industry. Keep this check-list handy as you shop for your health insurance coverage this year.
1. Know where to go.
A new state-based exchange will go into effect for 2021 in New Jersey. For anyone who purchased plans in the past on healthcare.gov you will now be directed to nj.gov/getcoverednj/.
I recommend calling the health insurance carriers directly with any specific plan questions. For example, at AmeriHealth New Jersey*, licensed sales agents are available by phone to help determine what plan is best for you. They can also submit an application on your behalf over the phone.
2. Mark your calendar.
All New Jersey residents are required to have health insurance coverage. So whether you are purchasing a consumer plan on nj.gov/getcoverednj/ or getting coverage through your employer, knowing your enrollment window is key to avoid tax penalties.
This year the consumer open enrollment period has been extended and will run from November 1 until January 31. If you purchase health insurance through your employer, pay close attention to deadlines for making plan selections. Once the window closes, there isn’t much flexibility unless you experience a life event like a marriage or if you have a baby.
3. Understand the nuances.
While open enrollment is extended this year, it’s important to make your selection as early as possible to ensure you are covered starting January 1, 2021. Also, take note of when you can expect your new member ID card and how you can access a digital version if needed.
4. Do the dollars make sense?
It’s important to consider the cost to buy versus the cost to use any health plan. For example, with high deductible health plans monthly premiums are affordable, but can be cancelled out by high deductibles or other fees like co-pays and co-insurance, which can add up quickly.
This is where transparency tools, like cost estimators, are important to help you compare estimated out-of-pocket costs. Check to see if the health plan you are considering offers these types of resources.
5. Do your homework on networks.
Chances are you and your family have formed relationships with the physicians you see regularly throughout the year and you’ll want to make sure they participate in the network you choose to avoid potential out-of-network fees.
Plans that offer in-network options only are generally less expensive. In addition, local networks can help control costs, while regional and national networks offer added flexibility.
6. Is there an app for that?
Renewing an existing health plan? You might be able to do it from the palm of your hand with a text. This is just one example of how the health care industry is leveraging technology like never before to provide a more seamless experience for you.
Knowing what kinds of digital engagement tools are available can enable you to do things like find health care providers, schedule appointments, manage a disease and provide wellness resources.
Moreover, the pandemic has accelerated the adoption of telehealth. Now it is here to stay. AmeriHealth New Jersey covered telehealth prior to COVID-19, but adoption was slow. To give you a sense of how popular it has become, AmeriHealth New Jersey had only about 300 telemedicine claims in January 2020. By April 2020, that number jumped to more than 14,000.
7. Get your questions answered the first time, every time.
Ask if the health insurance carrier provides direct access to live representatives who are readily available to assist you. It’s important to understand the customer service resources so you can maximize the value you’ll receive as a result of your purchase.
Lisa DiDio is director of sales for AmeriHealth New Jersey
*AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.