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Health plan pricing through Affordable Care Act coming next month

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Small businesses and individuals shopping for government-subsidized health plans on New Jersey’s exchange will learn the details — and pricing — for those new plans and their prices in mid-September, according to the Center for Medicare & Medicaid Services of the federal Department of Health and Human Services.

Individuals also can use the website www.healthcare.gov to learn if they are eligible for Medicaid, which is being expanded significantly under the Affordable Care Act. HHS estimates nearly 800,000 New Jerseyans will be eligible for either free coverage from Medicaid or subsidized coverage on the exchange.

New Jersey’s health exchange is being built by the federal government. Come Oct. 1, residents will be able to shop there for coverage; the ACA requires most Americans to have coverage by Jan. 1.

Ray Hurd, regional administrator of CMS, said during a Wednesday afternoon conference call that his agency and the states are now reviewing health plans submitted by health insurers “to ensure that the rates are justified, that plans meet the benchmark for essential health benefits, that they satisfy network adequacy requirements and that they don’t have discriminatory benefit designs.”

The insurers will offer plans in four different price categories. Lower-income New Jerseyans will be eligible for subsidies that are expected to significantly reduce the cost of coverage; the subsidies phase out at four times the federal poverty level, or $45,960 for an individual.

CMS spokesman Jeffrey Hall said the plans being offered, and their prices, will be posted at healthcare.gov in mid-September to provide sufficient time for individuals and small businesses to be ready for open enrollment.

Several health insurers have announced they will offer policies on the marketplace, including Horizon Blue Cross Blue Shield of New Jersey, Aetna, AmeriHealthNJ and the new, nonprofit cooperative insurance company Health Republic Insurance of New Jersey. Open enrollment runs from Oct. 1 to March 31.

During the conference call, Hurd urged community groups to become trained as certified application counselors who will help people get covered; the names of the CACs will be posted on the healthcare.gov website as resources for consumers and employers. The government is making grants to New Jersey organizations that will become navigators who help the public enroll, and the state’s federally supported health centers have received federal funds funding to hire staff to enroll the uninsured in health plans.

“We are doing all sorts of outreach activities in New Jersey,” Hall said, including public service announcements, and appearing on radio and television news shows to explain the program. The public will begin to see more mass media messages about the marketplace as the open enrollment date approaches, Hall said.

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