How to Sign Up for ACA Health Insurance in New Jersey

Posted on 04/25/22 by Emily Paulin

En Español |Most New Jerseyans are eligible to buy health insurance through GetCoveredNJ, the state’s Affordable Care Act (ACA) marketplace, during open enrollment, which runs from Nov. 1, 2022, through Jan. 31, 2023. Other residents who experience a qualifying life event — such as a marriage, divorce, the birth of a child, a move or lost health insurance — or who qualify for the state's new Expanded Access Special Enrollment Period may be eligible to buy or change coverage outside the open enrollment period.  

With a GetCoveredNJ plan, you may qualify for financial help to reduce the cost of your insurance. Three types of financial assistance are currently available: premium tax credits, cost-sharing reductions and New Jersey Health Plan Savings, a state subsidy. Premium tax credits and the state subsidy help lower your monthly premium payments, while cost-sharing reductions help lower your out-of-pocket costs like deductibles and co-pays.

Most people already enrolled in a GetCoveredNJ plan have seen their premiums go down because the American Rescue Plan Act of 2021 increased federal tax credits for insurance premiums and expanded the number of households who 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 only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person). The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will be available only through the end of 2022.  

Some New Jerseyans on a GetCoveredNJ plan also have access to a state subsidy called the New Jersey Health Plan Savings (NJHPS). Residents qualify for these savings based on income, with an individual earning up to $77,280 and a family of four earning up to $159,000 eligible for subsidies to lower health insurance costs. These savings are in addition to the federal financial help. 

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?

  • During open enrollment, which runs from Nov. 1, 2022, through Jan. 31, 2023. 
  • You can enroll outside of open enrollment if you experience a qualifying life event, but you generally have only 60 days from that event to enroll. This is called a special enrollment period. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances. 
  • Consumers with an annual income up to $25,760 for an individual or $53,000 for a family of four qualify for the state's Expanded Access Special Enrollment Period, allowing them to enroll any time of the year in plans with low or no monthly premium.


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
  • 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

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 annual income qualifies for federal tax credits for insurance premiums through 2022.  

For example, a single 64-year-old filer who earned $51,000 in 2021 could potentially have saved 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 savings based on income, with an individual earning up to $77,280 and a family of four earning up to $159,000 eligible for subsidies to lower health insurance 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 self-only coverage is less than 9.61 percent of your household income. Note that there are certain rules for minimum coverage and affordability that employer plans must meet. 

If you already have a GetCovered NJ plan but want to adjust your coverage, you’ll need to wait until the next open enrollment period to do so, unless you experience a qualifying life event or qualify for the state's Expanded Access Special Enrollment Period.

If you lose your COBRA coverage, you may be able to sign up for a GetCovered NJ plan during your 60-day special enrollment window. Try to apply and select your plan through GetCovered NJ before your COBRA coverage ends to make sure there's no gap in coverage.   
 
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.

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 April 25, 2022.

Also of Interest:

This story is provided by AARP New Jersey. Visit the AARP New Jersey page for more news, events, and programs affecting retirement, health care, and more.

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