Private Health Insurance in NJ, Lakewood

Log in / Sign Up

List of Forums + New Post Recipe Box Usergroups Following My Posts Bookmarks

Private Messages Advanced Search Rules New User Guide FAQ Advertise Contact Us

Forum -> Household Management -> Finances

1 2 Next

View latest: 24h 48h 72h

amother

Bronze

Sun, Sep 18 2016, 9:49 am

Anon because of many personal details.

I have private insurance with Horizon, expecting early next year b'ah.
My kids are about to lose their Jersey Family Care coverage due to change in income.

Could someone share your research into plans avaialable in Ocean County, specifically I use Dr. Giovine, Monmouth Hospital & Westpark Pediatrics.

I need to figure out the most economical plan, taking into account premium, deductibles and copayments for the following:

- myself, expecting delivery expenses early next year (means I will hit deductible BUT will be free of it for the rest of the year for my kids' care)
- 6-7 kids, with all the dr. visits and medications that always pop up: well checks, flus, colds, streps etc.

Horizon alone has several plans that may work, with minute differences. Right now I'm looking at Silver HSA and Silver Plans.

I really can't imagine researching dozens of plans with additional companies at this point.

Thanks in advance!

scrltfr

Sun, Sep 18 2016, 9:51 am

I have amerihealth and I'm pretty sure after the third kid you hit a cap on premium. Have you talked to a broker?

amother

Copper

Sun, Sep 18 2016, 9:53 am

I just used Rivka at Dacca insurance. She was amazing, helped me find insurance that would cover specific needs we have.
Using an agent doesn't cost you anything, the insurance you sign up with gives them commission. So I recommend calling her.
Good luck!

L K

Sun, Sep 18 2016, 10:50 am

scrltfr wrote:

I have amerihealth and I'm pretty sure after the third kid you hit a cap on premium. Have you talked to a broker?

What is your premium/deductible/copayment/co insurance?

amother

Bronze

Sun, Sep 18 2016, 5:23 pm

Does anyone have private insurance for kids and could share results of their research?

tymama

Sun, Sep 18 2016, 6:06 pm

We also have amerihealth NJ and phcs multi national plan
I highly recommend cosmo. They are amazing and will work with you and always available for questions.

amother

Bronze

Mon, Sep 19 2016, 5:10 pm

Whoever has amerihealth- did you compare it to horizon when selecting?

amother

Scarlet

Mon, Sep 19 2016, 5:24 pm

I had Horizon NJ health until last month when I was removed from Family Care. I met with an LRRC representative and we did an obama care application together. This will base your premium on your income. I ended up choosing the Silver Amerihealth plan which is what suited my needs best (bh I rarely go to the doctor) I was really glad I contacted the LRRC as they have a lot of information and can go through all the options with you. Also, I was able to put a tax credit towards my premium which was awesome since it brought down the monthly premium considerably.

Notsobusy

Mon, Sep 19 2016, 7:24 pm

First thing you should do is see if you qualify to get insurance through the marketplace. I found it very clear when I tried using it, I chose a bunch of policies in my price range, it gave me a page where I could compare the main details of a few at a time which made it very easy to choose. I wasn't able to use the marketplace in the end, but if you qualify, that's the cheapest way to go.

Otherwise you really should find a broker. The good ones can tell you right away what's best for your specific situation, they send you a few plans that could work for you and you choose what you like best. I personally worked with Slomo Finkel from Ideal Insurance. He was very pleasant and easy to work with, and I really felt like he knew what he was talking about.

I strongly recommend against Amerihealth, I had a huge problem with them recently, which took a few months to resolve. My broker said he has other clients with similar problems with them, as soon as I told him what was going on, he knew exactly which insurance company I was talking about.

Amarante

Mon, Sep 19 2016, 9:56 pm

You can use a broker even with Obsmacare as they receive a commission just as they would for insurance not purchased through the exchange.

I would recommend finding a very experienced agent because the plan yiu pick should be one that is most suited to your needs and plans can have subtle differentiations which a good agent will be aware of.

Notsobusy

Mon, Sep 19 2016, 11:45 pm

Amarante wrote:

I didn't know that you can use a broker with Obamacare, I wonder if that's true everywhere or does it depend on the state?

Amarante

Tue, Sep 20 2016, 12:18 am

glutenless wrote:

I didn't know that you can use a broker with Obamacare, I wonder if that's true everywhere or does it depend on the state?

I didn't realize it either.

There are some people called navigators who are licensed only to deal with Obamacare but a regular licensed broker can sell either one.

They collect commission on the premium before the subsidy so they don't make less money or at least they make enough so that they will do it.

In California, you either give the data to the broker who makes out the application or you do the application and designate the broker. They can then access your on line application.

Since it is a Federal law, I would imagine this is true for every state but it's easy enough to confirm.

I would suggest using a broker because a good one is very knowledgeable about the plans available on both the exchange and privately. the broker I used knew about networks and which hospitals were included in each plan. Of course, if yu have a specific doctor you want to see, you should check but that's true of amy plan, on or off the exchange now since so many plans have different network providers.

amother

Bronze

Tue, Sep 20 2016, 9:53 pm

Thank you for practical advice.

I spoke to mr. Finkel from Ideal. He was generous with his time and advice even though at this time I can't use his services because of being registered through exchange.

He confirmed that horizon Omnia silver appears to be the best choice for me.
I cannot decide though between silver hsa and plain silver one.
I checked the differences but deductible isn't super clear on the hsa one (whether delivery uses up deductible for one person or entire family amount of $3000).

Hsa premiums are significantly lower ($10/20 vs. $30/50, and with kids there are guaranteed to be visits for strep etc, plus my some of my kids see a specialist routinely).

it's not so clear which insurance is cheaper in the end because plain silver has a 0 deductible and a straightforward charge for delivery ($500/night).

Anyone has horizon Omnia silver plan?

Notsobusy

Tue, Sep 20 2016, 10:42 pm

I'm so happy Mr Finkel was able to help you, he really is so generous with his time and advice. Try calling Horizon, they should be able to explain the differences between the two plans to you. Good luck.

amother

Wine

Thu, Feb 16 2017, 10:45 pm

OP, I am moving to Lakewood in a few months and looking into buying a private Horizon plan. What did you end up choosing and how did it work out? I am in a similar situation with 5 kids which could potentially become 6. Wink

Anyone else with input on this topic, please share.

amother

Bronze

Thu, Feb 16 2017, 11:11 pm

amother wrote:

Anyone else with input on this topic, please share.

I don't have a final comparison because the year isn't up and I'm gonna know if I made the right choice only after I know exactly how much care we've used during the year.

So far here goes:
I ended up getting horizon omnia silver hsa because I was due in early January and reached the deductible right away.

Only caveat is that apparently deductible is allocated according to who bills first, so total of deductible and coinsurance I paid for services came out somewhat more than I had expected (I thought the hospital bills first, and then the drs. Turned out ob claimed for part of prenatal services even before delivery). Just have in mind that if you use different services whoever bills first gets the deductible first.

Oh, re delivery: bh, I had an uneventful delivery, so got a straightforward hospital bill plus one from anesthesiologist. In theory, it could've been more services and more charges if more doctors had been needed for me or baby.

So far, because deductible is up I'm paying much less in copay for both primary and specialists. It's $10 for primary, $20 specialist, $10 therapy like speech. For me it's good because my kids do see various specialists, one kid is getting therapy (that's total $600 less in copays for 30 sessions compared to the regular silver plan), one is seeing a specialist on a regular basis (savings of $120 per month).

So far so good. However, cumulatively we need several procedures done this year. I don't know yet how much it's gonna run. With silver hsa I'll prob have to pay 10% of the allowed amount. With silver it would prob be $250 each, not sure without a billing code.

Because deductible has been reached, this year I can get whatever medical supplies that are covered- without copays.

amother

Wine

Thu, Feb 16 2017, 11:20 pm

Wow, good for you. Seems you are very on top of your costs of care. What's your monthly premium like? Also, is Horizon widely accepted in Lakewood area? Do you know of any well regarded pediatricians or OBGs that specifically do NOT accept Horizon ? Thanks so much for your help!

amother

Ruby

Fri, Feb 17 2017, 12:28 am

Whoa. and I thought I was on top of things...

How does your Omnia Silver give you $10 copay and $30 specialist?! I have that plan and pay $30 copay, $50 specialist, and $35-$50/visit therapy (2 times a week now going up to 3-4...) how is that possible?! I live in Lakewood.

My monthly premium for Omnia Silver is 1300 I think and the out of pocket expenses are insane. Insurance and medical (therapy) costs are our highest expense (probably equal to or right after rent). We keep on telling ourselves "at least we're not in the ER and it's only money" but I don't understand how people "do it" - we certainly aren't!

amother

Bronze

Fri, Feb 17 2017, 12:45 am

Ruby, you *are* on top of things.
Yours must be "omnia silver", and mine is "omnia silver HSA."
If I'm correct your plan has a slightly higher premium and copays but 0 deductible for tier 1 providers, while I have a $3,000 family deductible for tier 1.

Coinsurance also differs somewhat, especially for maternity and other hospital-stay related charges (I think it's fixed dollar amount on silver vs a percentage on silver hsa).

Silver I think covers all the drs that one sees during hospital stay, and Coinsurance applies per night of stay. Silver hsa hospital stay falls under deductible and 10% coinsurance for the hospital and doctors.

Cost-sharing for Some procedures also differs, like flat $250 with silver, vs.10% with silver hsa.

And there's a difference in er deductible.

Whatever, may hashem grant us all good health so all this remains theoretical; and we should use medical services for happy occasions. Oh yes, and good Parnassah to pay all the bills comfortably.

amother

Wine

Fri, Feb 17 2017, 9:33 am

Thanks for the replies. With silver HSA, your deductible is higher but the money you spend can come from an HSA which is non-taxable, is that correct? Is that the main benefit over plain HSA?

Page 1 of 2

1 2 Next