Historic Levels of Financial Help Available with Expanded Health Insurance Options Coming 2023 in NJ

The New Jersey Department of Banking and Insurance last week announced that consumers shopping for 2023 health coverage this fall at Get Covered New Jersey, the state’s official health insurance marketplace, will benefit from historic levels of federal and state financial help.

New Jerseyans seeking healthcare through Get Covered NJ will have more options to choose from with Aetna now offering plans through the State, increasing the overall number of Get Covered NJ carriers for the second consecutive year.

“For the upcoming year, we have expanded the number of carriers offering plans through Get Covered New Jersey to five, up from three in 2020, and will continue to provide record levels of financial help to lower premiums,” said Commissioner Marlene Caride.

Open Enrollment begins November 1, 2022, at Get Covered New Jersey, which provides a one-stop shop for health insurance for residents who do not have coverage from an employer or other program, and is the only place residents can get financial help to purchase a health insurance plan.

The American Rescue Plan Act, signed in March 2021, significantly increased the amount of financial help available to consumers and removed the income cap to receive assistance.

The enactment of the Inflation Reduction Act earlier this year preserved these historically high levels of financial help that aim to make health insurance through Get Covered New Jersey more affordable for hundreds of thousands of New Jersey residents.

Based on these federal actions, NJ residents will pay no more than 8.5 percent of their income for health insurance through Get Covered New Jersey (based on a benchmark plan).

New Jersey also increased the number of state subsidies available to consumers through Get Covered NJ, extending eligibility to residents at higher income levels. This influx of federal and state funding allows those earning an annual salary of up to 600 percent of the federal poverty level ($76,560 for an individual and $157,200 for a family of four) to receive state assistance.

Due to this increased funding, The NJ Department of Banking and Insurance estimates that 9 in 10 NJ residents who apply to Get Covered NJ will qualify for financial assistance.

The Biden-Harris Administration is also proposing to eliminate the “family glitch.” If this proposal is finalized, family members of workers who are offered affordable self-only coverage but unaffordable family coverage may qualify for premium tax credits to put toward the purchase of plans on the marketplace.

As previously mentioned, consumers of Get Covered NJ will have more plans to choose from in 2023 with Aetna adding plans to the state’s health insurance portfolio.

Aetna will enter the marketplace in 2023, joining AmeriHealth, Horizon Blue Cross Blue Shield of New Jersey, Oscar, and Ambetter from WellCare of New Jersey.

Based on plan rates for 2023 submitted by carriers, rates will increase on average by 8.8 percent over 2022 in the individual market, which includes on-exchange and off-exchange plans (sold directly by insurance companies) and Small Employer Health Benefits Program rates will increase on average by 9.3 percent over last year.

However, due to federal and state funding, rates are significantly lower than they would be without efforts to stabilize the market. Rates in the individual market are an additional 15 percent lower than they otherwise would be as a result of the creation of the state’s reinsurance program in 2019, which seeks to better manage high-cost health claims.

The passage of the Inflation Reduction Act, and specifically the extension of increased levels of financial help, has led to a one and half percentage point reduction on average in marketplace plan rates in New Jersey.

Rate increases in the individual market are attributed largely to an increase in health care costs, also referred to as medical trends, according to information submitted by the carriers.

Another key driver of rates was increased medical claims, with the utilization of care greater than expected as residents seek healthcare services previously postponed due to the COVID-19 pandemic.

Insurers are required under the Affordable Care Act to use 80 percent or more of premiums for the payment of claims and to return excess premiums to policyholders. Once the full 2022 report is available, the NJDOBI will conduct an analysis and determine if rebates are owed to consumers based on all claims paid in 2022.

Rate filings are submitted to the department by carriers. By law, rate filings in the individual and small employer markets are informational and not subject to prior approval; however, the department may disapprove any informational filing if the department finds that the filing is incomplete and not in compliance with relevant laws or that the rates are inadequate or unfairly discriminatory.

The Open Enrollment Period for 2023 coverage at Get Covered New Jersey (GetCovered.NJ.gov) will run from November 1, 2022, to January 31, 2023. Consumers must enroll by December 31, 2022, for coverage starting January 1, 2023; if they enroll by January 31, 2023, coverage will begin February 1, 2023.

Below is the average total rate action by carrier in the individual market, which includes both on-exchange and off-exchange offerings:

Individual Market 2023 Rate Change

Carrier - Avg. Rate Change

• Aetna - As a new carrier in the market, a rate comparison to 2022 is not applicable.
• AmeriHealth - 7.8%
• AmeriHealth HMO - 8.5%
• Horizon - 9.4%
• Oscar - 6.7%
• Oxford - 8.2%
• WellCare - 5.4%
• Total Individual Market - 8.8%

Small Employer Market 2023 Rate Change

Carrier - Avg. Rate Change

• AmeriHealth - 11.8%
• AmeriHealth HMO - 14.2%
• Horizon - 8.3%
• Oscar - 7.6%
• Oxford - 9.4%
• Oxford HMO - 10.7%
• Total Small Employer Market - 9.3%

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