We all have health insurance!

This post marks a major update in our quest for health insurance. As of May 1, all four members of our family are officially enrolled in a health insurance plan! You can imagine my relief.

Get Covered NJ Eligibility Change

About a week after we updated our income on Get Covered NJ, we received a message in our Get Covered NJ secure inbox. The message informed us that we had an update in our eligibility. So, we logged on to our dashboard. Previously, our eligibility section showed that our kids were CHIP-eligible, and we needed to wait to be contacted by NJ FamilyCare.  This time, lo and behold, our kids were now eligible for insurance under the NJ Marketplace. Any reference to CHIP or FamilyCare was no longer there.

So, we signed up. The screenshot above is the policy we settled on.

The subsidies are way more than I would have ever imagined. In total, from both Federal and State, we are receiving $1467.70 per month. This means that our plan (originally priced at $1564.95) costs us only $97.25 per month!  A primary care office visit is $30, and a specialist visit is $50. Our MOOP is $16,000, and our deductible is $3,100. 

For now, I’m glad for the subsidies, but there’s a little part of me that thinks this is too good to be true. I know that part of these subsidies are due to the recently passed American Rescue Plan. It’ll be interesting to see how much the premiums go up for us once the pandemic is over. But again, for now, we’re glad. We’re counting our blessings.

What about NJ FamilyCare?

At the time that Get Covered NJ made our kids eligible for the NJ Marketplace, we had yet to hear anything from NJ FamilyCare.

Then, a few weeks after we enrolled our kids in the Marketplace plan above, we finally received correspondence in the mail from FamilyCare. They needed some additional documentation and income clarification. This showed us that they were just starting to process our application again. However, this time, we didn’t know if they were processing the application initiated by Get Covered NJ or the application we initiated on our own.

We called Get Covered NJ to make sure they weren’t waiting on FamilyCare in any way, and we found out they weren’t. After talking to a representative, we believe that our expected increase in annual income changed our status so that we were no longer CHIP-eligible. The representative didn’t say this explicitly, but she did say that she couldn’t see anyone on the application referred to FamilyCare on her side. And, she mentioned that income could have potentially changed that from before.

With that information, we called NJ FamilyCare and asked them to cancel our application. When they asked why, we cited that we were already insured through GetCovered NJ. The only reason we applied in the first place was because GetCovered NJ originally deemed us CHIP-eligible.

Horizon’s Update Timeframe

During this time, there was a little bit of a headache with Horizon, our chosen insurance carrier. It turns out that when they process a change from Get Covered NJ, it takes about 7-10 business days to fully process it. While that all sounds reasonable, the wonky part about it is that they seem to process everything a little bit piece-meal. What I mean is that they’ll update a little bit here on one day, and then a little bit there on another day. So, while they’re processing everything during that 7-10 business day timeframe, we don’t have a clear picture of what they have. 

For example, we paid for the newest May 1 policy premium through the Get Covered NJ dashboard. However, on May 1st, Horizon applied that amount along with an additional charge to cover the premium that corresponded to the first policy we had in April. When we checked Horizon’s website, we saw that they updated our insurance cards to the policy we had when we first updated our income, which didn’t include our kids. So, they received the funds without receiving the policy update, which should have included our kids. When we called a representative at Horizon to find out what was going on, she didn’t have any record of any policy except the one we originally had in April. As time went on, we checked back with Horizon’s website to see things slowly changing to what we expected.  Now, after 7-10 business days, things finally look right.

So, we know now that if there’s a change in subsidies via Get Covered NJ in the future, we should wait about a week for Get Covered NJ to send information over to Horizon. After that, we should wait another 2 weeks before Horizon’s system gets fully updated to accurately reflect our policy.

Dental Insurance for the kids only

One strange side-effect of getting our kids eligible for the Get Covered NJ Marketplace was that the dental plan we originally signed up for (when it was just me and Mr. FD) wasn’t available when our kids were added to the mix.

And, when I looked into the family dental plans for adults specifically, there wasn’t much benefit. All of the MOOPs and deductibles we saw were for children only, not adults. In the end, we only signed up our kids for dental insurance. We decided that if we parents wanted a cleaning or needed dental work, we’d pay out of pocket.

Initially, we thought that maybe we could somehow keep the dental insurance we already had (for the adults) while our kids got enrolled in a separate one. But, no dice. Our dental insurance was listed as terminated soon after we enrolled our kids in the Marketplace plans. And, when we called HealthPlex (our dental insurance from April), we tried to find information on how to stay on our plan. However, after a lot of phone transfers and pretty much no real answers, we gave up.

Some peace for now

Now that the dust has settled a bit, I can say that this process of enrolling in health insurance has been draining. We decided that we weren’t going to pursue another change in our health policy until the next open enrollment at the end of the year, if possible.

As of now, our whole family has decent health insurance. Our kids have dental insurance. We’re glad about that. We parents will get dental work done if we need to out-of-pocket. That’s good enough for us.  Monthly health insurance premiums, including the kids’ dental, now total about $130. We’re happy with that. 

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