Whether you’re just now looking to get your health insurance through the new marketplace or you’ve been shopping for a while, it’s important to understand how the marketplace works. Not only will this help you choose a plan that’s right for you, but it will also help you avoid costly mistakes.
Individual mandate
Having health insurance is an essential part of living in New Jersey. But the state’s health insurance marketplace is in need of help. This is why the state passed legislation to stabilize the market.
The New Jersey Health Insurance Market Preservation Act is a bill that will make the state’s health insurance markets more stable. The legislation will establish a reinsurance program that will offset the cost of the most expensive plans. It will also help payers cover the sickest members. Its success will depend on how much the state invests in the program.
The new law requires MEWAs to meet state standards. It also prohibits the sale of short-term, limited-duration policies in the state. These policies are used to provide health insurance to employees of two or more employers.
COVID-19
During the COVID-19 outbreak, many Americans have stayed home and focused on staying healthy. However, uncertainty can also exacerbate behavioral health needs. In response, Anthem has launched a suite of digital tools to help address these concerns. The Digital Data Sandbox is one of the largest certified de-identified health data sets in the U.S. Designed to help multiple stakeholders, this digital tool offers trusted information to improve patient care.
The Time for Care campaign, which is addressing specific health issues and chronic conditions, includes digital content and an employee assistance program. It aims to reinforce the importance of primary health care and encourage patients to use virtual visits.
Blue Cross Blue Shield of Michigan is expanding its telehealth services. Members will now have access to a nurse/provider hotline and virtual visits with specialists. The plan is also removing the limits on prescription refills for maintenance medications and testing. In addition, BCBSM is the first health plan in Michigan to offer free access to COVID-19 diagnostic tests.
High out-of-pocket costs
Despite all the talk about health insurance affordability, many Americans are still burdened by high out-of-pocket costs. This is especially true in states like New Jersey, where the state’s health insurance exchange offers record levels of financial assistance.
High out-of-pocket costs can include doctor visits, prescription medicines, and eyeglasses. These costs can add up quicklyFor instance, you can calculate your average annual costs for your prescription medicine.
You might also be eligible for a cost-sharing reduction, which helps pay for certain out-of-pocket expenses. Some people also qualify for premium tax credits, which reduce your monthly premium payments.
The federal government provides a subsidy for some health insurance plans, but it may not be enough to make coverage affordable. For example, people can receive a maximum out-of-pocket limit, which prevents them from going into debt to pay for unexpected medical costs.
Affordable care act (Obamacare) impacts
During the first year of the Affordable Care Act, 4.2 million Americans became newly insured. In addition to coverage, the law has provided a system of subsidies to help make health insurance affordable. It has expanded the number of households that qualify for tax credits. These households include those that earn less than 8.5 percent of the household’s income.
The ACA also mandated that insurers provide essential health benefits. It prohibited discrimination and coverage denials based on pre-existing conditions. In addition, it established a Medical Loss Ratio, which pushed premium dollars toward medical care.
The ACA also boosted Medicaid enrollment. In addition, the federal government increased the amount of money that families and small businesses could receive in tax credits to help pay for coverage.
Oscar Health’s return to the exchange
Founded in 2012, Oscar Health Insurance has been built on technology and offers a simple policy that is affordable for most. It uses data science to assess quality and volume of services and provides a mobile app that allows users to book appointments. It also has a curated network of doctors. Its main focus is on the individual market, but it is also expanding into new states.
Oscar’s new claims system is geared to minimize billing errors. It is also designed to keep up with the latest provider information. The company is in the process of rolling out its new claims system in 2018.
The company offers four plans, including a Medicare Advantage plan, a traditional health insurance plan, a co-branded plan with Humana, and a small group health plan for employers. It offers health-related cash incentives to members who reach specific goals. Customers can view all plans and costs online.
