Feds say nearly 44,000 New Jersey residents are overpaying for healthcare

While the Affordable Care Act has helped reduce healthcare costs for hundreds of thousands of New Jersey residents, many others who could be eligible for assistance still remain outside the reach of the federal reform.

That includes 44,000 Garden State customers who have purchased health insurance at full price on the open market, even though their incomes qualify them for tax credits that could add up to $300 a month, according to new analysis released Tuesday by the federal Department of Health and Human Services.

These New Jerseyans are among the 6.9 million Americans who are essentially overpaying for their health insurance by purchasing private plans when they are eligible for subsidized policies, the report found. More than 10 million more people nationwide are eligible for assistance through the ACA, but remain uninsured. This includes nearly 1 million Garden State residents, estimates suggest.

According to the researchers, “the large majority of the remaining uninsured would be eligible for tax credits to help purchase coverage, based on their income.”

 

DHHS suggested these people may not be aware they could benefit from government subsidies, or may not have been eligible in the past, but are now eligible, as premium costs rise faster than their income. The income ceilings are often higher than people think: a family of four that earns roughly $100,000 a year can qualify for subsidies.

The department said the findings are particularly important as the 2017 enrollmentseason for new ACA plans starts on November 1. Federal agencies remain concerned that the insurance reform has failed to reach all those in need and they continue to invest millions of dollars in efforts to help community groups sign up new participants; a handful of New Jersey groups will share $2 million released in September to assist in this process.

Expanding coverage remains a priority for a number of healthcare groups, including members of the NJ For Health Care coalition, which held a conference in September to discuss the current status of the ACA. They and others have urged increased government investment — particularly on the state and county levels — to ensure they can smoothly process applications. Their staffing levels have remained largely stable for years, despite increases in their work level, the group said.

Healthcare advocates have heralded the ACA as largely a success, although the program remains controversial politically. In New Jersey, more than 700,000 customers were added to the insurance rolls — nearly 500,000 through the expansion of the Medicaid program and almost 300,000 more through the ACA marketplace, an online store for lower-cost plans that can be purchased with the help of subsidies for those that qualify.

DHHS has found that, in New Jersey, 83 percent of these marketplace consumers received a subsidy, via tax credit, that amounted to $300 a month. As a result, more than one-third of these customers paid $100, or less, for their monthly coverage.

While tens of thousands of residents here are still missing out on these savings, New Jersey may be in better shape than some of its neighbors. The report found New York had 68,000 people who would qualify, but are not part of the marketplace; Pennsylvania — with 111,000 customers not getting benefits — is one of a half-dozen states with more than 100,000 residents overpaying for these plans.

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NJ Spotlight, an independent online news service on issues critical to New Jersey, makes its in-depth reporting available to NewsWorks.