With health care reform achieved by the 2010 Patient Protection and Affordable Care Act, state insurance authorities across the nation are faced with reviewing existing statutes or passing new laws to meet the new federal requirements. Already children are protected against insurance exclusion for pre-existing conditions and may stay on their parents’ health policies until their 26th birthday. (This protection does not distinguish for educational or marital status.)
Currently the states are operating high-risk insurance pools in concert with the U.S. Department of Health and Human Services to address the needs of adults with pre-existing conditions. On January 1, 2014, however, new health care exchanges will be activated in each state to provide a competitive marketplace to purchase coverage.
General Insurance Regulations
All New Jersey health policies are required to offer guaranteed renewability if the premiums are being paid, and rates cannot be set according to health status. Currently, insurers may exclude for pre-existing conditions for as long as a year, but the “look back” period is only six months. New Jersey companies may, however, deny coverage to any applicant, but Blue Cross Blue Shield is available to all consumers regardless of their current or past health.
Health Care Exchange
New Jersey is continuing to study options to implement the required health care exchange.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in the state is run by NJ Project and makes both primary and specialty care available to eligible participants, as well as coverage for stays in the hospital and for prescription medication. Premiums are set in the range of $245 to $947, with deductibles of $0-$2500. The out-of-pocket limit on all available plans is $5000 annually.
The formula used to determine eligibility for Medicaid benefits is based on the Federal Poverty Level. The same criteria applies to monies distributed through the Children’s CHIP-funded Medicaid Expansions. Infants under one year of age in New Jersey may collect Medicaid at 185% FPL and CHIP at 200%. Those in the age 1-5 age bracket qualify for Medicaid at 133% FPL, and those who are 6-19 at 100%, with CHIP eligibility at 133%.
Pregnant women may draw on Medicaid at 200% FPL, parents at 133%, childless adults at 23%, and non-elderly disabled Social Security recipients at 74%.
The NJ Family Care program provides coverage to children that do not have any health insurance at 350% of the federal poverty level or more. The NJ Cancer Education and Early Detection Screening Program provides cancer testing for qualified men and women for breast, cervical, prostate and colorectal cancer screenings.
Approximately 15 percent of the state’s population draws Medicare benefits, with more than 1.2 million people relying on prescription drug coverage. There are ten assistance programs offered through the New Jersey Health Link program, and the PACE or Programs for the All Inclusive Care for the Elderly offers additional aid to Medicare recipients for medical care and out-of-pocket costs. Counseling and educational services for Medicare recipients are available through the State Health Insurance Program.