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Horizon is a not-for-profit organization.

For more than 90 years, our not-for-profit mission has been central to who we are and why we exist. Working hard to make high quality healthcare more affordable for our members is a responsibility we take seriously.

Nothing impacts your health insurance premiums more than the cost of healthcare: nearly 90 cents of every premium dollar pays a claim going directly to providers — health systems, hospitals, doctors, pharmacies, and others delivering care. To lower those costs, Horizon negotiates reduced prices with all of those providers on your behalf.   

Just 7 cents of every dollar goes to pay the costs of administering our health plans — and we’re working to reduce those as well (see below). The rest of your premium dollar pays state and federal taxes and other regulatory charges.

Since medical claims make up nearly all of your premium cost, higher charges from providers contribute the most to rising premium costs.

High healthcare costs impact your access to care.

According to the Centers for Medicare and Medicaid Services (CMS), healthcare spending in the US grew 4.1 percent in 2022. Hospital care, doctors and other medical professionals, and retail prescription drugs make up most of that spending. When health systems, hospitals, doctors, or drug companies raise their prices, it becomes harder for Horizon to hold the line on increases in your health insurance premiums, deductibles, and co-pays. 

Horizon is New Jersey’s hometown health insurer. We know that healthcare is expensive here in New Jersey, and that rising costs can sometimes force our members to skip needed care, or not fill a prescription to save money. Medical costs should never prevent someone from getting the care they need. All of us in healthcare have a role to play in controlling medical costs — particularly when inflation is making it harder for families to make ends meet. 

We are committed to doing our part to push back on rising healthcare costs and give Horizon members access to care they need — at a price that is fair for our members as well as the hospitals and doctors who care for you.

Here’s what we’re doing to address rising costs for our members:

Reducing our operating costs

Partnering with doctors and hospitals

Lowering member out-of-pocket costs

Improving access to care

Reducing our operating costs

Just as our members do with their family budgets, Horizon is also finding ways to do more with less. We owe it to you to be smart about how we spend the small part of the premium dollar we use to administer the health care benefits of our 3.7 million members. While still achieving the highest customer satisfaction ratings of any health insurer in New Jersey, we have worked hard to improve the cost of our own operations, saving $122 million last year with an expected $75 million in additional savings over the next year. 

Partnering with doctors and hospitals

Horizon is working to make sure you are getting the most for your money by collaborating with our network doctors and hospitals to think carefully about how care is delivered, and make sure that your healthcare dollars are getting results. Keeping price increases down means everyone in the healthcare system doing their part — eliminating wasteful care that doesn’t deliver good results and controlling administrative costs.  All of us have a responsibility to remember that higher costs result in higher premiums and out of pocket expenses for you. 

One way we reduce costs is by reimbursing doctors and hospitals based on the results they deliver for our members. Rather than paying them to deliver more care, we are incentivizing them to deliver better care. That change alone saved our members nearly $250 million in 2022. 

Another way we’re lowering costs is by using technology to help members with chronic conditions like diabetes, COPD, or heart disease stay on top of their health and avoid serious complications that can send them to the hospital. Since 2020, those programs have prevented more than $25 million in unnecessary health costs while actually improving health outcomes for our members. 

Lowering member out-of-pocket costs

“Why did that cost so much?” — it’s a common question, and one you may have asked after seeing the charges for recent care. The fact is, as with most things, there are ways in healthcare to lower costs and still get good care and the right results. We’re finding ways to lower your out-of-pocket costs by rethinking the ways healthcare works. For instance, injectable medicines can be life-changing for people who need them. But they are more expensive when you receive them at a hospital — so we’ve partnered with providers to make it possible for you to get some of those shots at your doctor’s office or in your home. It’s the same medication, it just costs less — and it’s more convenient for our members!  In a similar way, we’re focusing on helping you get prescription drugs at the lowest cost. We’re doing this by providing doctors, pharmacies and members with tools that automatically find lower-cost options that are just as effective.

Improving access to care

Good care means getting the right care, in the right place, at the right time. Good care also leads to lower overall healthcare costs. That’s why we are constantly building new partnerships and working to expand our network with options that make it easier and more convenient to get good care. We have doubled the number of in-network mental and behavioral health professionals available to our members. And if you can’t see your primary care doctor, a growing network of telehealth options and urgent care centers can help you get care without an expensive and unnecessary trip to the emergency room. With 8,500 more doctors, specialists, and other health care professionals in our network — a 13.5% increase from 2022 — Horizon members now have more than 72,000 options for in-network care. Making it easier to find the care you need in-network means lower costs for everyone.

We are driven to improve health care quality, cost, and member experience. We are committed to continuing to work with doctors, hospitals, and prescription drug companies across New Jersey to ensure you have access to quality in-network care at a fair price, because healthcare costs should never be a barrier to care.