En Español | Most New Jerseyans are eligible to buy health insurance through GetCoveredNJ, the state’s Affordable Care Act (ACA) marketplace, now that open enrollment has begun. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March 2021 coronavirus relief bill and the state’s new Health Plan Savings subsidy.
Most people already enrolled in ACA marketplace plans will also see their premiums go down because of this federal and state help. Because of these changes, 9 in 10 consumers enrolling in a GetCoveredNJ plan now qualify for financial assistance. As of now, this additional assistance will be available only in 2021 and 2022.
Who is eligible?
To buy health insurance through GetCoveredNJ, you must:
- Live in the U.S. and have a primary residence in New Jersey
- Be considered a resident of the U.S. and New Jersey for tax purposes
- Be a U.S. citizen or national, or a noncitizen who is lawfully present in the U.S.
- Not be incarcerated
You may also qualify for NJ FamilyCare, the state’s publicly funded health insurance program, offering free or low-cost coverage to uninsured low-income individuals and families. When you apply for coverage through GetCoveredNJ, your income and household information will be used to determine if you qualify for a NJ FamilyCare plan, or another insurance program, including Medicare or Tricare.
Those not eligible for GetCoveredNJ or NJ FamilyCare plans can still apply for other members of their household who are eligible. For instance, a parent who is not lawfully present in the U.S. can still enroll their children in health insurance through GetCoveredNJ if the children are eligible.
When can I enroll?
- Now. GetCoveredNJ's open enrollment period began on Nov. 1 and runs through Jan. 31. Enroll by Dec. 31, 2021 for coverage beginning Jan. 1, 2022. Enroll by Jan. 31, 2022 for coverage beginning Feb. 1, 2022.
- The state's special enrollment period for 2021, which was introduced in response to the pandemic, is also still in effect meaning you can enroll for coverage starting Dec. 1, 2021 during November.
- You can enroll outside of open enrollment if you experienced a qualifying life event — such as the birth or adoption of a child, a divorce or a marriage, or a job loss. This is called a special enrollment period.
- Those who qualify for NJ FamilyCare can enroll anytime.
How do I sign up?
You apply for coverage and choose your plan at the same time. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. You can pay online or ask to receive a bill in the mail. To apply and enroll:
- Online: Visit the GetCoveredNJ enrollment page. If you had health coverage through HealthCare.gov or NJ FamilyCare in 2020, your account will now live on the GetCoveredNJ site – you can access your account via this enrollment page, too.
- By phone: Call 833-677-1010 (toll-free)
- In person: You’ll need to meet with a certified assister or broker; find one through the GetCoveredNJ website. Click the Help & Support Menu, then choose “Find Local Assistance.” Call 833-677-1010 (toll-free) if you require extra assistance. More information is online.
You can also call GetCoveredNJ (833-677-1010) or meet with an assister or broker for help with exploring plans, to ask questions and to help determine if you qualify for financial assistance. Visit GetCoveredNJ’s online customer service center for more information.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family. If you qualify for NJ FamilyCare, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your income level.
All GetCoveredNJ plans cover the “essential” health benefits, including:
- Ambulatory care (outpatient) services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services, including annual physicals and mammograms
- Chronic disease management
- Pediatric services
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All GetCoveredNJ plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan may cut costs.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of its annual income now qualifies for federal tax credits for insurance premiums.
A single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
The state is also offering a new subsidy, called New Jersey Health Plan Savings (NJHPS), that helps lower your premiums. New Jersey residents qualify for these new savings based on income, with an individual earning up to $76,560 and a family of four earning up to $157,200 eligible for subsidies to lower health coverage costs. Those who qualify can see their lower premium using GetCoveredNJ’s Shop and Compare Tool or after filling out an application.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for an almost $0/month premium health coverage option, thanks to the American Rescue Plan. This extra financial help will expire at the end of 2021, unless it is extended.
What plans are available?
GetCoveredNJ plans are organized into five categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover between 70 and 94 percent of care costs, depending on how much financial help you qualify for. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums. No platinum plans are currently offered by GetCoveredNJ.
- Catastrophic plans have low monthly premiums but a very high deductible. They’re available to individuals under age 30 and to those who qualify for a hardship exemption. These are an affordable way for people to protect themselves from the costs of a serious illness or injury, but people with these plans pay most routine medical expenses themselves.
Use the state’s Shop and Compare Tool to compare plans and costs based on your income, household size and county of residence.
What if I already have health insurance?
If you or your spouse have job-based insurance, the only way you will qualify for financial help on GetCoveredNJ is if your insurance does not meet minimum standards for affordability and coverage. A job-based health plan is considered "affordable" if your share of the monthly premiums for the lowest-cost coverage is less than 9.83 percent of your household income for an individual or less than 8.27 percent for a family. Note that there are certain rules for minimum coverage and affordability that employer plans must meet.
If you are currently enrolled with an insurance provider outside of GetCoveredNJ but have become eligible for lower premiums under a GetCovereredNJ plan, you can switch now through Jan. 31, 2022.
If you already have a GetCoveredNJ plan but want to adjust your coverage based on any new financial help you may be eligible for, you have from now until Jan. 31, 2022 to do so.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you can switch to a GetCoveredNJ plan. The federal government fully subsidized COBRA coverage through to Sep. 30, 2021, but is no longer doing so. Use GetCoveredNJ's Shop and Compare Tool or meet with a certified assister or broker to see whether the switch is right for you.
Note that during summer, GetCoveredNJ automatically updated financial help for as many existing consumers as possible who hadn't taken action, so existing customers may have already seen their plans updated. But current enrollees who have received unemployment compensation in 2021 need to update their application.
If you are insured under Medicare, you are not impacted by the expanded federal tax credits in the March coronavirus relief bill or the state’s new Health Plan Savings subsidy.
Will I need to get a new doctor?
That depends. Major insurance providers, including AmeriHealth and Horizon Blue Cross Blue Shield, offer GetCoveredNJ plans, but not all doctors accept them. You can talk to your primary care physician or use the Shop and Compare Tool to see whether a particular doctor or practice will accept a marketplace plan.
This guide, originally published June 3, was updated on Oct. 1, when GetCoveredNJ's open enrollment period began.