Individual health insurance plans
Choosing a health plan can be a complicated process. But at AmeriHealth New Jersey, we think finding the right plan — one that meets your needs and helps protect your health and financial well-being — is worth the effort.
It’s why we offer a wide variety of plans for you to choose from, and why we’re committed to helping you find the one that’s right for you.
How individual health insurance plans work
Individual health plans are made up of many parts, and understanding those parts is your key to choosing a plan. Here’s a look at some of the terms you’ll see:
Plan types
We offer several types of health plans including Health Maintenance Organizations (HMOs), Point-of-Service (POSs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs). Each of these plans works a little differently and will determine things like whether you will need a referral to see a specialist, how much you will pay out of pocket when you get care, and if you need to use in-network providers. Take a closer look at the different types of health plans we offer.
Catastrophic coverage
AmeriHealth New Jersey also offers catastrophic coverage to people younger than 30 and to those who qualify due to extreme hardship.
Health Savings Accounts
We offer a health saving account (HSA) option with several of our high deductible plans. An HSA can help you save money on out-of-pocket health care expenses.
Provider network
We have four provider networks: National Access, Regional Preferred, Regional Preferred with NY Access, and Local Value. The networks differ based on location as well as the participating doctors, hospitals, and other health care providers.
Referrals
Some of our plans require that you get a referral from your doctor before seeing a specialist. Your doctor will send the referral to the specialist’s office to notify them that you need to see them for medical care. After the referral is received, you can make an appointment with the specialist.
Health insurance marketplace
Get Covered NJ is the state’s official website where individuals and families can shop for and buy health coverage. It is the only place to apply for financial help to lower your monthly premium and out-of-pocket costs.
Metallic categories
Under the Affordable Care Act, every health insurance plan on the health insurance marketplace is assigned a metallic category. Our plans fall into three metallic categories: Gold, Silver, and Bronze. The categories can help you compare your plan options based on how much you will pay towards your premium each month and your out-of-pocket costs when you receive care.
Tax credits (subsidy)
A tax credit is an amount of money that the government is required to pay towards your health insurance. You must qualify to receive a tax credit, and how much you qualify for depends on your income and the number of people in your household. You may be eligible to receive tax credits, pay less for health care services and products, or both.
New Jersey Health Plan Savings
Additional financial help is also available to lower your monthly premiums through Get Covered New Jersey. This is a new benefit provided by the state of New Jersey, called New Jersey Health Plan Savings.
Open enrollment
This is the time when you can enroll in or change your existing health plan.
Special enrollment period
You may qualify for a Special Enrollment Period to enroll any time if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. Learn more about SEPs.
When you’re ready to enroll
If you qualify for a tax credit or New Jersey Health Plan Savings, you should enroll on the health insurance marketplace at Get Covered NJ. If you don’t qualify, you may enroll directly through AmeriHealth New Jersey.
* You may opt out of our pediatric dental benefits if you wish to purchase them through another insurer.
¹AmeriHealth New Jersey dental plans are administered by United Concordia Companies, Inc.
²Administered by Davis Vision, an independent company.
³An AmeriHealth affiliate has a financial interest in Visionworks.
4Guardian Insurance products are underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.
5LifeSecure Insurance Company underwrites and has sole financial responsibility for the Personal Accident Insurance product.
