How to get Marketplace health insurance in New Jersey

En Espanyol |Most New Jersey citizens are eligible to purchase health insurance. Get Covered NJ, the state Affordable Care Act (ACA) market during the open registration period from November 1, 2022 to January 31, 2023.People who have children, move, lose health insurance, or qualify for new state coverage Extended Access Special Registration Period You may be eligible to purchase or change coverage outside of the open enrollment period.

The GetCoveredNJ plan allows you to receive financial assistance to reduce your premium. There are currently three types of financial assistance available. Premium tax credits, reduced cost sharing, and savings from the state-subsidized New Jersey Health Insurance Program. Premium tax credits and state subsidies reduce your monthly premium payments, and reduced cost sharing reduces out-of-pocket costs such as deductibles and copayments.

Most people already in a GetCoveredNJ plan have their premiums lowered as the U.S. Relief Plans Act of 2021 increased federal tax credits on premiums and expanded the number of households covered by the premiums . Any household that pays her 8.5% or more of household income can qualify for a federal tax credit to help pay for health insurance. Before the new law went into effect, such tax credits were only available to those who made up her 400% of the federal poverty level (about $51,000 per capita). According to the federal government, the average American with a Marketplace plan will save $50 a month with this new assistance. Currently, this additional federal financial assistance is available to him only until the end of 2022.

Some New Jersey residents on the GetCoveredNJ plan New Jersey Health Insurance Plan Savings (NJHPS)Residents are eligible for these savings based on their income, with an individual income up to $77,280 and a family of four income up to $159,000, eligible for subsidies to lower health insurance premiums. . These savings are in addition to federal financial assistance.

GetCoveredNJ homepage

Courtesy of GetCoveredNJ

Who qualifies?

To purchase health insurance through GetCoveredNJ, you must:

  • Live in the United States and have a primary residence in New Jersey
  • Considered a resident of the United States and New Jersey for tax purposes
  • Be a U.S. citizen or national, or a non-citizen legally residing in the U.S.
  • not be imprisoned

You can also qualify New Jersey Family Care, a state publicly funded health insurance program that provides 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 your eligibility for the NJ FamilyCare Plan or other insurance programs, including: Medicare Also Tricare.

If you are not eligible for a GetCoveredNJ or NJ FamilyCare plan, you may still apply to other members of your household who are eligible. For example, parents not legally residing in the United States can enroll their child in health insurance through GetCoveredNJ if the child is eligible.

When can I enroll?

  • During the open registration period from November 1, 2022 to January 31, 2023.
  • If you have experience, you can enter other than general admission. Eligible Life Event, but you usually only have 60 days from the event to register.this is Special admission periodEligible events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce, and other special circumstances.
  • Consumers with an annual income of up to $25,760 for an individual or up to $53,000 for a family of four must Extended Access Special Registration Periodyou can enroll anytime of the year for plans with low or no monthly premiums.

How do I sign up?

Apply for insurance and choose a plan at the same time. Once your plan is approved, you will need to pay your first monthly premium to start your coverage. You can pay online or ask to receive an invoice by mail. To apply and register:

  • online: visit GetCoveredNJ registration pageIf you had health insurance through or NJ FamilyCare in 2020, your account will appear on the GetCoveredNJ site. You can also access your account from this registration page.
  • on the phone: Phone 833-677-1010 (toll-free)
  • directly: You must meet with a certified assistant or broker.find one through GetCoveredNJ website.[ヘルプとサポート]Click the menu and[ローカル アシスタンスを探す]Choose. For further assistance, please call 833-677-1010 (toll-free). Learn more online.

You can also call GetCoveredNJ (833-677-1010) or meet with an assistant or broker to help you research your plan, ask questions, and determine if you are eligible for financial assistance. Visit GetCoveredNJ online Customer service center for more information.

What is covered and how much does it cost?

Coverage and costs vary depending 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 New Jersey Family Caredepending on your income level, you may be able to get free or low-cost coverage and not have to worry about premiums or out-of-pocket costs.

All GetCoveredNJ plans cover “essential” health benefits such as:

  • Outpatient (outpatient) services
  • emergency service
  • hospitalization
  • maternity and newborn care
  • Mental Health and Substance Abuse Services
  • Prescription drugs
  • Rehabilitation and rehabilitation services and devices
  • Inspection service
  • Preventive and wellness services such as annual checkups and mammograms
  • chronic disease management
  • Pediatric services

Insurers cannot deny coverage based on pre-existing 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 included basic dental services For children, such as cleaning and exams. However, adults who want dental insurance must add it to their policy. Deductibles and copayments vary by plan. Subscribing to a Family Girlfriend plan may save you money.

What about new federal subsidies for insurance premiums?

All eligible households that pay more than 8.5% of their annual income in premiums are eligible for a federal tax credit on their premiums through 2022.

For example, a 64-year-old filer who earned $51,000 in 2021 could have saved more than $8,000 with the new tax credit. Kaiser Family Foundation.

Is there any other financial assistance available?

yes. If you qualify for a premium tax credit, you may also qualify for cost sharing reductions to help pay for out-of-pocket expenses such as deductibles and co-payments. You must be enrolled in the Silver level plan to receive this assistance.

The state also offers a new subsidy called new jersey health insurance savings (NJHPS) to help lower insurance premiums. New Jersey residents are eligible for these savings based on their income, up to $77,280 for individuals and up to $159,000 for families of four, and receive subsidies to lower health insurance premiums. I am eligible.Those who qualify can use GetCoveredNJ to lower their premiums Shop and comparison tools Or after completing the application form.

What plans are available?

GetCoveredNJ’s plan is They fall into five categories:

  • bronze plan It has the lowest monthly premiums, the highest deductibles and copayments, and covers approximately 60% of medical costs. They are designed to help you in case of serious illness or injury.
  • silver plan There are reasonable monthly premiums, deductibles and out-of-pocket costs. Covers 70-94% of medical costs, depending on the level of financial assistance you qualify for. It is the only plan eligible for the Cost Sharing Subsidy.
  • gold plan It has a high monthly premium, low deductibles and copayments, and covers approximately 80% of medical expenses.
  • Platinum plan It has the highest monthly premiums, the lowest deductibles and copayments, and covers approximately 90% of medical costs. These are for people with critical medical needs who are willing to pay the highest premiums. There are currently no platinum plans offered by GetCoveredNJ.
  • devastating plan Monthly premiums are low, but deductibles are high. Available to individuals under the age of 30 and those eligible for hardship exemption. They are an affordable way for people to protect themselves from the cost of serious illness or injury, but people with these plans pay for most routine medical bills themselves.

of the state Shop and comparison tools Compare plans and costs based on income, household size and country of residence.

What if I already have health insurance?

If you or your spouse have occupation-based insurance, the only way to qualify for financial assistance with GetCoveredNJ is if your policy does not meet the minimum standards of affordability and coverage. Job-based health insurance is considered “affordable” if the lowest-cost self-insurance-only monthly premium burden is less than 9.61% of household income. Note that there are certain rules about the minimum coverage and affordability that your employer’s plan must meet.

If you already have a GetCovered NJ plan and would like to adjust your coverage, you will need to wait until the next Open Enrollment Period unless you have a qualifying life event or are eligible for the state’s Extended Access Special Enrollment Period .

If you lose your COBRA coverage, you may be able to sign up for the GetCovered NJ Plan during a special 60-day enrollment period. Apply and select a plan through GetCovered NJ before your COBRA coverage period ends to ensure there are no gaps in your coverage.

If you have an NJ FamilyCare plan that includes Medicaid, Medicare, and Tricare, you are not affected by increased federal tax credits or state NJHPS subsidies.

do i need to get a new doctor?

it depends. Major insurers such as AmeriHealth and Horizon Blue Cross Blue Shield offer GetCoveredNJ plans, but not all doctors accept them. consult your doctor or Shop and comparison tools Check if a particular doctor or clinic accepts Marketplace plans.

This guide was originally published on June 3rd and was updated on April 25th, 2022.

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