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 2021 American Rescue Plan Act (ARPA) 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. These enhanced subsidies are now available through 2025.
Prior to the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
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 $81,540 and a family of four earning up to $166,500 eligible for subsidies in 2023 to lower health insurance costs. These savings are in addition to the federal financial help.
To buy health insurance through GetCoveredNJ, you must:
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.
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:
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.
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:
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.
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of over $950.
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 subsidy, called New Jersey Health Plan Savings (NJHPS), that helps lower your premiums. New Jersey residents qualify for these savings based on income. In 2023, an individual earning up to $81,540 and a family of four earning up to $166,500 are eligible. Those who qualify can see their lower premium using GetCoveredNJ’s Shop and Compare Tool or after filling out an application.
GetCoveredNJ plans are organized into five categories:
Use the state’s Shop and Compare Tool to compare plans and costs based on your income, household size and county of residence.
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 9.12 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 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 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.
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 Nov. 7, 2022, with information about new income guidelines to qualify for state subsidies and expanded access special enrollment.
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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