New Jersey Offers Its Public Employees a Direct Primary Care Doctor at No Cost. It Just Approved a 17.3 Percent Premium Increase for Local Government Workers Anyway.

Analysis by DPC Insider — Policy Desk
#employer DPC#New Jersey#public employee benefits#health plan design#premium increases#Marathon Health
Sources: Direct Primary Care, New Jersey Division of Pensions & Benefits · Rate Renewal Reports, New Jersey Division of Pensions & Benefits · Update: NJ SHBP and SEHBP Rate Renewals – Where Do They Stand? · NJEA statement: SEHBC rejects proposed 34 percent rate increase for third time · Officials just deadlocked on a 34% insurance hike for N.J. teachers — but the fight isn't over · Deadlock on steep health insurance cost increases for school staffs · SHBP for Active Members, New Jersey Division of Pensions & Benefits

New Jersey’s public employee health plans already include a direct primary care doctor at no cost to the member. No membership fee, no copays, same-day appointments, eleven clinics from Fair Lawn down to Cherry Hill. On September 3 the State Health Benefits Commission approved a 17.3 percent premium increase for local government workers anyway.

Both things are true at once. The gap between them is the most useful thing a DPC reader can take out of New Jersey this month.

What the state actually offers

The Direct Primary Care program runs inside the State Health Benefits Program and the School Employees’ Health Benefits Program. Members pick a doctor at Marathon Health, formerly Everside Health, and the state describes the deal in plain language: “Zero membership fee and no copays for unlimited access to your personal primary care doctor.”

The rest of the list reads like any DPC practice’s front page. Same-day and next-day appointments for urgent issues. Evening and weekend availability. Call, text and video chat with the doctor 24/7. On-site blood work at no cost. Basic medications for acute conditions and immunizations at no cost.

Eleven Marathon Health offices carry it: Cherry Hill, Clifton, Ewing, Fair Lawn, Hamilton, Jersey City, New Brunswick, Toms River, Voorhees, West Orange and Willingboro. Active employees, non-Medicare retirees and their dependents qualify if they sit in Horizon NJ DIRECT or Aetna Freedom, Horizon OMNIA or Aetna Liberty Plus, the CWA Unity plans, the NJ Educators Health Plans or the Garden State Health Plan.

One detail matters more than the feature list. Joining requires no change to the member’s health insurance.

That is the shape of the thing. It’s a rider bolted onto a conventional plan, not a replacement for one.

What happened on September 3

New Jersey runs two commissions for two populations, and they met on the same day to opposite effect.

The state’s rate renewal page dates the plan year 2027 full text rate report for the local government group to September 3, 2026. A summary of that renewal published by the benefits firm Benecard puts local active employees at 17.3 percent, split into 16.7 percent medical and 20 percent prescription, with early retirees at 36.6 percent and a combined 22.1 percent across the local group.

The school employees’ commission got nowhere. Aon, the state’s actuary, recommended raising active-employee premiums 34.4 percent, NJ.com reported. A 4-4 split carries nothing. It split 4-4 in August. On September 3 the NJEA said it had rejected the increase for the third time. At its July 27 meeting the same commission did approve the smaller retiree numbers, 11 percent for early retirees and 6 percent for Medicare retirees.

Commissioner Dan Holub, who directs research and economic services for the NJEA, voted against the increase back when the commission deadlocked on August 19. “If we pass this, we’re going to be right back here in a few months dealing with another crisis,” he said at that meeting. “I just can’t in good conscience as fiduciaries support that.”

He has the trend line behind him. NJ.com reported the plan’s active-employee premiums climbed 6.3 percent, then 14 percent, then 31.9 percent across the three increases before this proposal.

Why the record never mentions the DPC benefit

Labor’s counter-proposals were about oversight, not care delivery. The NJEA said its representatives put forward three resolutions on September 3: an independent review of program management, an evaluation of claims administration, and immediate financial relief for districts facing the increases. Management voted all three down 4-4. Nothing on the table concerned primary care, and the joint statement from NJEA’s president, vice president and secretary-treasurer stayed on the money: “Every dollar diverted to unnecessary health insurance costs is a dollar that cannot be invested in students, educators and educational opportunities.”

The September 3 agenda, the NJEA’s statement and the published accounts of both meetings don’t mention the DPC program either. That omission follows from how the benefit is built.

The state presents the DPC program as an add-on that leaves the member’s coverage alone. A member who joins Marathon Health keeps the same Horizon or Aetna plan underneath it. The employer is still buying that plan in full. Whatever the DPC clinic prevents shows up, if it shows up at all, as claims that never arrive, spread across the plans’ whole risk pool and set against a 20 percent prescription increase.

Set that beside what Corunna Public Schools did in Michigan. Corunna pays Plum Health $90 a month per employee for an on-campus clinic serving all 255 staff, while its insurance plan reaches 110 of them. That district bought primary care as a line item and can point at the invoice. New Jersey offers an option and points at a phone number.

Neither approach is the honest one to recommend from here. They’re different purchases, and only one of them produces a number a school board can argue about.

The Open Question

The program page doesn’t say how many New Jersey public employees actually use it.

It lists eleven addresses, five patient testimonials and a toll-free number. It carries no enrollment count, and it was last updated in April 2025. Without that figure nobody can tell you whether the direct primary care benefit is a rounding error inside a 22 percent increase or the one line that held.

The gap cuts both ways, which is the reason to name it rather than fill it. A DPC advocate can’t hold up New Jersey as proof the model bends a large employer’s trend. A skeptic can’t point at the 17.3 percent and call it a failed experiment. Both would be arguing about a denominator neither of them has.