The Sentinel Project guide to buying health insurance in New Jersey, released by Seton Hall Law School, is an excellent resource for NJ consumers shopping for health insurance.
The guide is particularly salient now, since we’re in the midst of the 2015 open enrollment period for health insurance. Consumers have from November 15 to February 15 to sign up for insurance. New Jersey consumers use Healthcare.gov; New York consumers use NY State of Health.
As I’ve written previously, I believe private health insurance through the Affordable Care Act for people with special needs can be an attractive option in certain situations. The ACA means insurers have to cover people with pre-existing conditions, which includes many people with special needs, and insurers must cover essential health benefits like mental health treatment, chronic disease management and habilitative care.
When compared with Medicaid, private insurance offers advantages and disadvantages for people with special needs. Insurance is much more expensive. You must pay premiums, co-pays, co-insurance and deductibles. With Medicaid, most care is free or very low-cost. But private insurance generally offers you more choice in what doctors you can see, and may pay for services that Medicaid won’t. More choice can lead to both better health care, and more self dignity.
With private insurance, you also avoid having to repay Medicaid from your estate or special needs trust when you die. This can be very attractive for someone with a large special needs trust who wants to leave the remainder to his spouse, children or other loved ones.
Private insurance won’t cover long term care, so it won’t pay for services like a nursing home or group housing. You still need Medicaid to avoid paying for long term care out-of-pocket (with some nuances). But private insurance covers acute medical care very well – routine care, doctor visits, hospital stays, surgery, medicine, etc.
If you are considering using private insurance as part of special needs planning, we’d be happy to talk with you; call or email us today.