The question everyone asks when it comes time to picking their health insurance. It’s definitely a tough one and their own situation will play into the answer I give. I’ve been in the health insurance game for over ten years, and I’ll share what I believe to be the best plan is in NJ and what you should be looking at for your family. Most people think it’s one of the Platinum plans available. I disagree 100%.
What is the best health insurance plan? The Horizon Blue Cross Omnia Bronze H.S.A is in my opinion the best choice overall in NJ when you are selecting a plan for your family or small business. The combination of low premiums, easy to understand network tier structure, extra perks like BFit(gym reimbursement), telemedicine and its H.S.A qualified status all contribute to its success.
Read on and I’ll go over how the plan works, and why I think it belongs in your top list of health plans whether you are a family looking for coverage or a small business.
When I am working on quotes for a small business or family, the first thing people want to know is the cost. I evaluate all of the plans with Amerihealth NJ, Horizon BCBS and any other carriers that are available at the moment. Across all of the age groups, the Bronze H.S.A will be one of the lowest.
The best way to compare the plans is to take the monthly cost for your plan and get the annual total. Then add the annual total to the maximum out of pocket. The maximum out of pocket(MOOP), is the most you can pay in a calendar year for your claims. If you hit that number, you are then covered 100%. I’ll show a few examples.
I’ll compare the Horizon Omnia Bronze H.S.A and the Amerihealth EPO H.S.A Advantage $250/$50 plan. My rates are for a 51 year old in the 08201 zip code in 2019.
| Plan | Omnia H.S.A | Amerihealth H.S.A |
| Maximum Out of Pocket(MOOP) | $6,550 | $6,750 |
| Annual Premium | $6,234 | $4,878 |
| Total | $12,784 | $11,628 |
You’ll see here the total cost if the 51 year old had the worst case scenario. The full premium and hitting the max out of pocket. The Amerihealth plan is actually cheaper. The premium is 28% less which is very significant. If you came looking for the cheapest premium, look no further and go with the Amerihealth plan I mentioned.
The Horizon plan falls behind in the premium comparison, but among the other Horizon plans, it will be the lowest cost plan.
The Bronze H.S.A plan is HSA qualified so it has a large upfront deductible before benefits will be paid.
In this case, the deductible is $3,000 that you need to pay before Horizon pays anything. When you visit a provider, they apply the network discount and you pay based on that amount. Once the deductible has been met, you pay copays or coinsurance until the year is over or you hit the max out of pocket of $6,550 per person or $13,100 for a family.
The Horizon Omnia network for small groups and individuals is exactly the same as their Advantage plans. It is all of NJ, the Philadelphia region, a small part of Delaware and New York City.
The big thing that makes a plan Omnia from a consumers perspective is the use of a Tiered network.
Omnia Tiers
Each quote you get for a Horizon Omnia product will show Tier 1 and Tier 2 benefits. Depending on how your provider is classified, they will be one or the other. Tier 1 providers will have a lower deductible and copay than Tier 2 providers. I don’t have data to support this, but there is no discernable difference between the quality of providers in either Tier. Horizon BCBS has their own way of deciding who goes into what Tier, but that discussion is a whole other issue.
Tiers on the Omnia Bronze H.S.A
The one thing I really don’t like about Omnia, the Tiers, doesn’t affect this plan. With the Omnia Bronze, the deductible in Tier 1 is $3,000 and the deductible in Tier 2 is also $3,000. That makes it simple. Some of the plans have different deductibles and it can be very confusing to try and compare anything out.
When visiting providers, any claim that goes towards Tier 1 will also count towards your Tier 2 deductible. It will fill both buckets. When you visit Tier 2 providers, it only fills the Tier 2 bucket until that one is full($3,000). If you happen to reach that first, you won’t have to pay any more deductible in either tier for the rest of the year.
This plan is H.S.A qualified. Going into the details of an H.S.A will be saved for another post, but I will give some of the details and benefits below.
Certain health plans are deemed HSA qualified by the IRS and they carry with them certain benefits.
Those are the big benefits of the H.S.A. I can’t stress enough how important it is to have the extra flexibility for a tax deduction. For most people, they won’t have large enough expenses in a year to deduct much if anything of their health care costs. The H.S.A is a fix for that. Also, the health insurance tax credit is a cliff based on your Modified Adjusted Gross Income.
If your income is below the threshold, you can get a large credit, possibly thousands of dollars. If you are a dollar over that limit, you get zero! With the H.S.A, you can make a last minute contribution and get the credit by lowering your taxable income.
The Horizon Bronze H.S.A is perfect for this set up. A HRA is something employers will set up for their employees. As employees have claims, they are able to be reimbursed by their employers on a tax free basis. The HRA makes this work.
When we are helping small employers shop their health insurance, the goal is to always maximize benefits at the lowest possible price. Many employers have Gold and Platinum level plans because they want good plans for their employees. These plans are extremely expensive and there will be many employees who never use the benefits. Money wasted.
We recommend buying the lowest priced plan with a good network, the Horizon Omnia Bronze H.S.A. This way they can cover their employees with the lowest possible premium, but give them good benefits by reimbursing the employees as the claims are incurred. Platinum benefits for Bronze prices. We see up to 30% savings when moving to an HRA setup and this plan is perfect for it.
Horizon offers Telemedicine on all of their Omnia plans. This is the way of the future in my opinion.
If you have an illness that doesn’t require an emergency room visit, you can download the Telemedicine app and reach a doctor through your cell phone from the comfort of your home.
I have personally used this a few times and the experience was fantastic. One morning I felt terrible and was pretty sure I had the flu. The last thing I wanted to do was to get to a doctor with the way I felt. I installed the app on my phone and was teleconferencing a doctor within a few minutes. I went over my symptoms, held the phone at my face so the doctor could get a look at me and they were able to make a quick diagnosis over the phone. The doctor called a prescription into my local pharmacy and it was ready fifteen minutes later. I saved myself the time and hassle of getting to an urgent care center or waiting for my primary care doctor to be able to see me.
Telemedicine does have a cost, which is somewhere around $50 until the deductible is met. The price changes from time to time so don’t hold me to that amount. It is definitely cheaper than your alternatives though.
For a long time the BFit program was only available to large group employees. BFit will reimburse you up to $20 month/$240 annually for regularly going to the gym.
The only catch is the gym must participate with the program and you need 12 documented visits per month. It’s actually pretty easy and great benefit.
Just like the BFit program, this is available on all of the plans. It is definitely worth mentioning though because many people don’t know about it.
My recommendation is you check through site to see what they have and go back often before making purchases to see if you can save some money. As I write this, they are showing a 20% Reebok discount and up to 40% off Davis Vision Products. There are hundreds of deals that may work out great for you.
Hopefully you will agree that the Bronze H.S.A plan is a solid choice. Once you look past the large deductible and compare actual benefits, you will find this plan hard to beat. The Amerihealth plan I mentioned is a solid choice, but will not have everything this plan does. Also, you will come to find the Platinum, Gold and Silver plans will cost you thousands more over the course of the year when compared to the Bronze and its max out of pocket.
Which health insurance company is best? There is really no answer for this. It is subjective based on your location, the plan you choose and other demographics. Each state will have its leaders and in NJ we have Horizon BCBS, Amerihealth and Oxford Health.
How do I choose the best health insurance? I hope you use my guide above to see the types of things I look at. Overall cost, network, other perks like gym reimbursements and H.S.A options are great.
Is it illegal to not have health insurance? No, absolutely not. There used to be federal tax penalty for not having health insurance but that has gone away. Some states like NJ, have started their own tax penalty to bolster the insurance pool. It’s not illegal to not have it, but you will pay a tax penalty in some cases.
Mike Sheeran, CFP has been working in New Jersey Health Insurance marketplace for over ten years with Glenn Insurance, Inc in Absecon, NJ.
New Jersey Insurance - Absecon NJ 08201-Serving North, Central and South Jersey.
