How to Sign Up for ACA Health Insurance in New Jersey

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• Key dates: Open enrollment runs from Nov. 1, 2023, through Jan. 31, 2024.

• Where to apply: Visit GetCoveredNJ, the state’s Affordable Care Act (ACA) marketplace.

• What’s changed: In 2023, GetCoveredNJ introduced a new special enrollment period for consumers who are losing their NJ FamilyCare (Medicaid/CHIP) eligibility. In 2024, families with an offer of job-based insurance that’s newly considered unaffordable may become eligible for savings with GetCoveredNJ plan.

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.

Depending on your income, you may 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 (also known as Medicaid/CHIP). 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, such as Medicare, for people 65 or older, or Tricare, for active-duty and retired uniformed services members and their families.

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.

• Most New Jerseyans can apply for 2024 coverage during open enrollment, which runs from Nov. 1, 2023, through Jan. 31, 2024.

• If you qualify for the state’s Expanded Access special enrollment period, for consumers with an annual income up to $27,180 for an individual or $55,500 for a family of four ($29,160 for an individual or $60,000 for a family of four in 2024), you can enroll year-round in plans with low or no monthly premium.

• If you qualify for NJ FamilyCare, you can enroll year-round.

• If you have lost or are going to lose NJ FamilyCare coverage due to the federal government’s ending of pandemic-era Medicaid rules, you qualify for a special enrollment period for a GetCoveredNJ plan. You have 120 days to enroll in a GetCoveredNJ plan from when your NJ FamilyCare coverage ends, but should do so within 60 days of coverage ending to avoid a gap.

If you don’t qualify for a special enrollment period, you’ll only be able to buy health insurance after open enrollment if you experience a qualifying life event. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances. In most situations, you’ll have just 60 days from that event to enroll.

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.
• 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.
• By mail: Download an application online or call 833-677-1010 to have one mailed to you. Once complete, mail the form to:
  
  Get Covered New Jersey
  Attn: Application
  PO Box 55898
  Trenton, NJ 08638

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. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan may cut costs.

All GetCoveredNJ plans cover the “essential” health benefits, including:

• Ambulatory care (outpatient) services
• Emergency services
• Hospitalization
• 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

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.

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.

GetCoveredNJ plans are organized into five categories:

• Bronze plans have the lowest monthly premiums and the highest deductibles and copays. They 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 70 to 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. They cover roughly 80 percent of care costs.

• Platinum plans have the highest monthly premiums and the lowest deductibles and copays. They cover roughly 90 percent of care costs. These are for people who have significant healthcare needs and are willing to pay the highest premiums.

• 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.

The federal government increased tax credits for insurance premiums in 2021 and expanded the number of households that qualify for them. As a result, most people enrolled in ACA marketplace plans have seen their premiums go down. This expanded financial assistance is available through 2025.

• If your annual income is below 150 percent of the federal poverty limit ($21,870 in 2024 for an individual and $45,000 for a family of four), you may be eligible for zero-premium coverage, depending on the plan you choose.

• If your income is between 150 percent and 400 percent of the federal poverty level (up to $58,320 for an individual and $78,880 for a couple), you are eligible for a premium subsidy. The amount depends on your income and your plan.

• If your income exceeds the above limits, you can still get a premium subsidy if your monthly charge for the most popular silver-level plan would be more than 8.5 percent of your income.
  

If you’re eligible, GetCoveredNJ will automatically apply the credits when you enroll.

New Jersey started offering a subsidy in 2021 called New Jersey Health Plan Savings (NJHPS) that helps lower premiums for New Jersey households with annual incomes up to 600 percent of the federal poverty level. In 2024, an individual earning up to $87,480 and a family of four earning up to $180,000 are eligible. Those who qualify can see their lower premium via GetCoveredNJ’s Shop and Compare Tool or after filling out an application.

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.

If you're insured under a NJ FamilyCare plan — including Medicaid, Medicare, and Tricare — you're not impacted by the expanded federal tax credits or the state’s NJHPS subsidy.

• 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 unaffordable if the premiums are more than 8.39 percent of the family’s household income.

• If you’re independently enrolled in a private health insurance plan, not through your job, you may qualify for significant savings if you switch to a GetCoveredNJ plan. You’ll need to switch during open enrollment, unless you experience a qualifying life event or qualify for the state's Expanded Access special enrollment period.

• If you already have a GetCoveredNJ plan but want to adjust your coverage, you’ll need to do so during open enrollment, unless you experience a qualifying life event or qualify for the state's Expanded Access special enrollment period.

• If you were receiving temporary continuation of your health care coverage under COBRA, and that coverage has ended, you may be able to sign up for GetCoveredNJ plan during a 60-day special enrollment window. Try to apply and select your plan before your COBRA coverage ends to make sure there’s no gap in coverage.

A pandemic-era provision that allowed those enrolled in NJ FamilyCare who were no longer eligible for the insurance to maintain their coverage ended on March 31, 2023. Since then, NJ FamilyCare has been contacting enrollees when it’s time to renew their coverage to determine if they still qualify. All consumers are slated to be contacted before March 31, 2024.

If you no longer qualify for NJ FamilyCare because your income is now too high, you may be eligible to enroll in a GetCoveredNJ plan. If you lose NJ FamilyCare coverage, you’re considered to be experiencing a qualifying life event, so have 120 days to enroll in a GetCoveredNJ plan once your NJ FamilyCare coverage ends. Try to apply and select your plan before your NJ FamilyCare coverage ends to make sure there’s no gap in coverage. However, to avoid duplicate coverage and potential tax implications, wait until you have received confirmation that you are no longer eligible for NJ FamilyCare coverage.

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.

It depends. Family members in the same household may qualify for different programs because of their age, income, disability, caregiver status or immigration status. Such families may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted or whether their provider accepts Medicaid coverage. If you're not sure what makes the most sense for your family, get free advice from a certified insurance broker or assister.

In 2024, families with an offer of job-based insurance that is considered unaffordable — if the premiums are more than 8.39 percent of the family’s household income — may be newly eligible for savings on a GetCoveredNJ plan. In prior years, the affordability calculation used the cost of job-based coverage for the employee only, even if the employee was seeking coverage for the whole family. Now, the cost of family coverage is used in the affordability calculation.


This guide was updated on Nov. 6, 2023, with updated information about 2024 open enrollment.

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