In the interest of full disclosure, for the last fifty years I have done everything from process health insurance claims to design and manage health benefit plans to negotiate provider contracts and run HMOs, so when I say the choices offered in the marketplace are confusing to the average person … trust me.
Here is a sample of plans in the New Jersey marketplace. Healthcare.gov has been quietly modified to allow you to see the plans before you actually open an account (a feature that should have been there from the start). It’s not easy to find, but it’s there.
Do you know what an EPO is? Is it a bit confusing that different levels and types of plans rather than being organized are presented in a mix?
Look at these plans and their prices and especially look at the prices of the plans offered by Health Republic of New Jersey. Do you see much difference in the prices between this plan and the others? Look at the first two in the list, both are EPOs (Exclusive Provider Organizations meaning very limited networks). Or as healthcare.gov says:
Exclusive Provider Organization (EPO) Plan
… A managed care plan where services are covered only if you go to doctors,
specialists, or hospitals in the plan’s network (except in an emergency). …
The first is a silver level plan and the second a gold level meaning lower out-of-pocket costs and yet there is only a $10 monthly difference in premium. The last two are gold level EPOs yet the Health Republic of New Jersey plan is $30 more.
Now here’s the good part. Remember all the talk of insurance company profits, we need competition and such, well now that you have seen the results, you should know this about Health Republic of New Jersey:
We are Health Republic Insurance of New Jersey – a non-profit Consumer Operated and Oriented Plan (CO-OP) established through the Affordable Care Act. We provide cost-effective & comprehensive healthcare coverage to the people of New Jersey.