Community-Rated Medigap Insurers: Who's Included In New Jersey?

which medigao insurers are community rated in new jersey

New Jersey offers a range of health insurance options, including Medicaid for those whose income is below 138% of the Federal Poverty Level. The Centers for Medicare & Medicaid Services (CMS) awards star ratings to Medicare Advantage plans annually, with UnitedHealthcare receiving a top rating of 5 stars in New Jersey for 2025. Aetna CVS Health is another popular choice, offering affordable plans with lower-than-average out-of-pocket expenses and a low denial rate of 21%Horizon Blue Cross Blue Shield of New Jersey is also notable for its low out-of-pocket costs and impressive score of 79 out of 100 from MoneyGeek.

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Aetna CVS Health

Aetna members can create an account on the member portal to access benefits and shop for approved products online or through the CVS OTC Health Solutions app.

However, it is important to note that Aetna CVS Health plans may not be available in all states, and certain benefits may be excluded in specific states. For example, the $25 allowance for CVS Health brand products and MinuteClinic services are not available in California, Missouri, or New Jersey.

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Horizon Blue Cross Blue Shield

Horizon BCBSNJ has one of the largest networks of doctors, hospitals, and specialists in New Jersey. As a Horizon NJ Health member, you can access in-network specialists without referrals and benefit from low or no copays for primary care office visits and preventive services.

The company also hosts Community Health Advisory Committee meetings with members, community health advocates, and leaders to discuss ways to improve services, health education, and outreach activities.

Reviews of Horizon Blue Cross Blue Shield of New Jersey are mixed. While some customers have had positive experiences, others have reported issues with obtaining approval for services, long call wait times, and difficulties locating doctors.

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AmeriHealth

In addition to hospitalizations and doctor visits covered under Original Medicare Parts A and B, AmeriHealth's Medicare Advantage plans may also cover outpatient care, prescription drugs, dental, vision, hearing, and other perks. The plans have a range of monthly premiums, out-of-pocket costs, and covered services.

New Jersey residents can take advantage of several resources to learn more about Medicare and insurance options. New Jersey's Medicare Information and Referral Service offers free, unbiased counseling over the phone for older adults. The state also has 21 Area Agencies on Aging, each responsible for developing community-based systems of services for older adults and advocating for their needs. Additionally, the New Jersey State Health Insurance Assistance Program (SHIP) provides in-depth and objective insurance counseling and assistance to Medicare-eligible individuals and their families.

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UnitedHealthcare

The Community Plan offers Medicaid and D-SNP (Dual-Eligible Special Needs Plans) coverage for adults aged 19-64 with incomes up to 133% FPL (Federal Poverty Level). The eligibility criteria also consider family size, including children under 21, adoptive and natural parents, and caretaker relatives. UnitedHealthcare also offers Individual & Family ACA plans in New Jersey with Bronze, Silver, and Gold metal levels, providing flexible options for customers.

The UnitedHealthcare Community Plan in New Jersey provides benefits such as vision, dental, and hearing care. It also offers health education programs to promote healthier lifestyles for its members. The plan covers routine eye exams and provides assistance for eyeglasses and contact lenses. Dental coverage includes cleanings, checkups, and necessary dental work. Hearing benefits include tests, check-ups, and hearing aids, although some limitations may apply.

Additionally, UnitedHealthcare offers the Managed Long-Term Services and Supports (MLTSS) program, catering to frail, elderly, and disabled individuals. This program combines traditional healthcare benefits with long-term services, such as assistance with daily living activities at home or in the community.

For those seeking Medicare Advantage plans in New Jersey, UnitedHealthcare is one of fourteen private health insurance providers offering these plans in the state. Medicare Advantage plans are an alternative to original Medicare coverage, often bundling Parts A and B while also covering prescription drugs and vision. UnitedHealthcare's Medicare Advantage plans are rated by the Centers for Medicare & Medicaid Services (CMS), which uses a five-star rating system to evaluate overall performance.

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Kaiser Permanente

Doctor.com can help individuals find doctors who accept Kaiser Permanente insurance in New Jersey, including internal medicine physicians, family medicine physicians, paediatricians, diagnostic radiologists, emergency medicine physicians, obstetrician/gynaecologists, orthopaedic surgeons, and other healthcare providers.

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