En Español | Most New Jerseyans are eligible to buy health insurance through GetCoveredNJ, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill and the state’s new Health Plan Savings subsidy. Because of these changes, 9 in 10 consumers enrolling in a GetCoveredNJ plan now qualify for financial help. And because of the pandemic, GetCoveredNJ’s enrollment window is open through the end of 2021.
Most people already enrolled in ACA marketplace plans will see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households that qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were available only to people making up to 400 percent of the federal poverty level (around $51,000 for a single person).
The average American family with a marketplace plan can save $50 per person, per month with the new assistance, the federal government says. As of now, this additional federal financial 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?
- Anytime through the end of 2021
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.
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 the end of the year.
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 the end of the year to do so.
If you change plans without a gap in coverage, the amount you paid in 2021 toward your deductible in your current plan will go toward your new deductible. But any costs that have accumulated towards your out-of-pocket maximum for your current health plan will not be carried over.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you can switch to a GetCoveredNJ plan. Be aware that if you don’t cancel your COBRA plan before your new plan kicks in, you may face a financial penalty.
Note that this summer, GetCoveredNJ is automatically updating financial help for as many existing consumers as possible who have not yet taken action, so existing customers may not need to update their plans. But current enrollees who have received unemployment compensation in 2021, who do not currently receive financial help, and who have opted to apply only a portion of their financial help to their premium each month will 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.
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