New Jersey Health Insurance: Find Affordable Plans

New Jersey residents have access to several types of health insurance. You can enroll in employer-sponsored coverage through your job, buy a private plan, or even sign up for Medicare or Medicaid.

This guide explains your New Jersey affordable health insurance options in detail.

• Marketplace plans: In New Jersey, you can purchase a private health plan directly from one of six insurance carriers if you’re self-employed, if your employer’s plan doesn’t offer group coverage, if your employer’s plan doesn’t meet your needs, or if the plan doesn’t cover your spouse or dependents. Individuals and families interested in purchasing Affordable Care Act (ACA) health insurance plans can do so using New Jersey’s Health Insurance Marketplace at Healthcare.gov.
• Open enrollment: Open enrollment starts on November 1 and runs until January 31. Due to the COVID-19 pandemic, New Jersey opened a special enrollment period scheduled to last through the end of 2021. You can sign up for coverage during this period, even if COVID-19 hasn’t affected you personally.
• Special enrollment: Most years, you can’t purchase health insurance outside of open enrollment unless you qualify for a special enrollment period. You may qualify if you lose your previous health coverage, become ineligible for Medicaid (or another government insurance program), or turn age 26 and lose eligibility for your parents’ insurance plan. Other qualifying events include moving to New Jersey, adopting a child, having a baby, getting married, becoming a U.S. citizen, and experiencing changes in income that affect your coverage options.
• GetCoveredNJ: New Jersey is one of several states that doesn’t use the federal Health Insurance Marketplace. If you want to buy a marketplace plan, you must use the GetCoveredNJ site rather than the HealthCare.gov site.
• Premium tax credit: If you don’t want to use GetCoveredNJ to purchase health insurance, you can buy directly from one of New Jersey’s insurance companies. Keep in mind that you won’t qualify for help paying your premiums if you don’t use the exchange to enroll.
• Coverage types: In New Jersey, just over 55% of residents have health coverage through an employer. Another 30.4% have Medicare or Medicaid. The rest of the insured population has military coverage (0.5%) or non-group coverage (5.4%). Nearly 8% of New Jersey residents have no health coverage.

To enroll in New Jersey’s health insurance marketplace, visit the GetCoveredNJ website. If it’s your first time visiting the site, follow the instructions to create an account. You’ll need to provide some basic details, such as your name and contact information. If you already have an account, log in with your username and password.

If you’re applying during open enrollment, you can simply fill out the application, compare plans, and sign up for the plan that best meets your needs. You’ll also have an opportunity to see if you qualify for help paying your health insurance premiums. If you’re applying outside of open enrollment, you’ll need to select a qualifying life event from the list provided. Qualifying events include marriage, loss of coverage, and loss of eligibility for Medicaid or NJ FamilyCare.

To compare plans, enter your ZIP code, your date of birth, and your annual household income. If other people in your household need coverage, enter their dates of birth. You’ll be able to review available plans, check their monthly premiums, and explore the services each plan covers.

If you need local assistance, you can use the Find Local Assistance tab in the portal to find a Certified Navigator. The following companies offer health

The following companies offer affordable health insurance in New Jersey:

• Aetna CVS Health
• AmeriHealth HMO
• AmeriHealth Insurance Company of New Jersey
• Horizon Blue Cross Blue Shield of New Jersey
• Oscar Garden State Insurance Corporation
• Oxford Health Insurance
• WellCare Health Insurance Company of New Jersey, Inc.

Although you follow the same enrollment steps whether you’re shopping for an individual or family plan, it can be more difficult to determine which health plan is best for multiple family members. As an individual, you can shop based solely on your needs and preferences, making it a little easier to choose a plan.

Insurance for individuals in New Jersey

Plan type, monthly premium, and total annual cost are among the most important factors to consider when buying health insurance. In addition to reviewing the monthly premium, you need to think about the annual deductible (the amount you must pay before your insurance starts to pay for covered services), the copay for each service, and what percentage of your medical expenses you’re expected to pay out of pocket. In many cases, the plans with the lowest premiums have the highest deductibles. These plans may also require you to pay a larger percentage of your health care costs.

You may be able to buy an HMO, PPO, POS, or EPO plan. The type of plan you select may affect your access to certain specialists or medical facilities, so it’s important to choose carefully.

• Preferred Provider Organization: PPO plans have the fewest restrictions; for example, you don’t have to choose a primary care provider, and you can see a specialist without asking for a referral.
• Health Maintenance Organization: HMO plans usually cost less than PPOs, but also have more restrictions. If you choose an HMO plan, you’ll need to pick a doctor, nurse practitioner, or physician assistant to serve as your primary care provider (PCP). You’ll also be required to ask your PCP for a referral any time you want to see a specialist.
• Point of Service: POS plans are a type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.
• Exclusive Provider Organization: EPO plans are a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).

When it’s time to choose a plan, pick the one that gives you the best combination of affordability and access to care. If you’re on a limited budget, you may want to choose the plan with the lowest premium. If you can afford to spend a little more, it may be better to choose a plan with a higher premium but a lower out-of-pocket maximum.

Insurance for families in New Jersey

If you’re shopping for coverage for multiple people, you need to consider your choices even more carefully. A single person without any health problems has a lot more flexibility than a consumer with a spouse or multiple dependents. For example, if you have kids, you’ll want to look for a plan that offers coverage for pediatric care. If your spouse has diabetes, then you’ll want to look for a plan that covers endocrinology care and has reasonable copays for insulin and other diabetic medications.

The type of plan you select is also important, especially if anyone in your household has a chronic health problem. If one of your dependents has kidney disease, for example, you may want to choose a PPO plan so you don’t have to ask for a referral every time they need to see a specialist. If everyone is in good health, then it may make sense to choose an inexpensive HMO plan to save money on your monthly premiums.

If you use New Jersey’s health insurance exchange to shop for coverage, you need to understand the metal tier system. Marketplace plans are classified under different metal names to make it easier for consumers to compare costs – Bronze, Silver, and Gold.

For private health insurance plans, base rates in 2021 range from $242.50 per month to $1,031.72  per month. The base rate is multiplied by an age rating factor to determine the total premium, with younger consumers paying less for their coverage than older consumers.

• Bronze plans have the lowest monthly premiums, but usually have the highest deductibles and out-of-pocket maximums. In 2023, the most affordable Bronze plan in New Jersey costs $358 per month, up from $328 per month in 2018. If you sign up for a Bronze plan, you can expect to pay 40% of the cost of each covered service.

• Silver plans have higher premiums than Bronze plans, but also tend to have lower deductibles and out-of-pocket maximums. This means you may pay less for a Silver plan than you would for a Bronze plan when you consider the monthly premium, annual deductible, coinsurance requirement, and out-of-pocket maximum. Additionally, you can’t get help paying your premiums unless you choose a Silver plan or above. If you enroll in a Silver plan, you can expect to pay 30% of the cost of each covered service. In 2023, the most affordable Silver plan in New Jersey costs $435 per month.
• Gold plans are among the most expensive, but also have lower deductibles, copays, and out-of-pocket maximums. If you choose a Gold plan, you’ll only pay 20% of the cost of each covered service. Therefore, a Gold plan may be the best choice if you have ongoing medical expenses. In 2023, the most affordable Gold plan in New Jersey costs $674 per month.

New Jersey offers Medicaid coverage to residents with low income as well as the aged, blind, and disabled. Older residents may also qualify for institutional/nursing home Medicaid, which has a higher monthly income limit than the other plans. NJ FamilyCare offers coverage for certain residents who earn too much to qualify for standard Medicaid.

Medicaid in New Jersey

Medicaid is available to New Jersey single residents who earn no more than $1,133 per month in income and married applicants who have an income of no more than $1,526 per month. The Medicaid program also has financial resource limits; which means you can’t have more than a certain amount of cash, stocks, bonds, and other assets in your possession. For single applicants, the limit is $4,000; married applicants are allowed to have up to $6,000 worth of financial resources.

Institutional/nursing home Medicaid has a monthly income limit of $2,523 and asset limits of $2,000 for single applicants and $3,000 for married applicants if both spouses are applying for coverage. If only one spouse is applying for Medicaid, then the applicant must have no more than $2,523 in assets. The non-applicant spouse may have up to $137,400 in financial resources.

In addition to meeting the financial requirements for Medicaid coverage, you must also be a resident of New Jersey and a U.S. citizen or lawful immigrant. To apply for Medicaid, visit NJHelps.org and click Get Started. If you’re not sure if you meet the eligibility requirements, complete the screening process, which takes about five to 10 minutes.

NJ FamilyCare

If you earn too much to qualify for Medicaid, you may qualify for NJ FamilyCare if you’re pregnant or have at least one dependent in your household. For pregnant women, the income limit is up to 205% of the federal poverty level (FPL). If you have a dependent in your household, you can earn as much as 138% of the FPL and still qualify for NJ FamilyCare. Children aged 18 and under also qualify for NJ FamilyCare coverage if their parents or caregivers have household incomes of no more than 355% of the FPL.

To apply for coverage, fill out the application at NJHelps.org, call NJ FamilyCare at 1-800-701-0710, or contact your County Board of Social Services.

You may qualify for Medicare if you’re at least 65 years old or have a qualifying disability. In most cases, you need to receive SSDI benefits for at least two years before you become eligible for Medicare, but there are exceptions for people with end-stage renal disease and amyotrophic lateral sclerosis (Lou Gehrig’s disease). You also need to be a U.S. citizen or lawful immigrant to qualify.

• Original Medicare includes Part A and Part B coverage. Part A pays for services you receive in a hospital or other type of inpatient facility, home health, and hospice, while Part B covers services you receive on an outpatient basis, including doctor visits, X-rays, lab tests, and immunizations.
• If you want more comprehensive coverage, you can purchase a Medicare Advantage Plan, which covers Part A and Part B services as well as prescription medications. Some Medicare Advantage Plans also cover hearing aids, medical transportation, gym memberships, and other services not covered by Original Medicare. In 2022, New Jersey had 66 Medicare Advantage Plans available, not including special needs plans and PACE plans.

If you choose Original Medicare, you can purchase Medicare Supplement Insurance (Medigap) to defray some of your out-of-pocket expenses, including deductibles and coinsurance.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months’ worth of payments from the Social Security Disability Insurance program. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

The New Jersey State Health Insurance Assistance Program (SHIP) provides Medicare beneficiaries, their families, or their caregivers with free, unbiased, and confidential advice and counseling on their Medicare options in New Jersey. This includes providing information about Original Medicare, Medicare Advantage Plans, Medicare Part D, and other aspects of Medicare. These trained and certified counselors can also help you with other health insurance questions and will never try to sell you a plan.

New Jersey prohibits insurance companies from selling short-term, limited-duration health insurance.

• American Council on Aging | New Jersey Medicaid Income & Asset Limits for Nursing Homes and In-Home Long Term Care | Last accessed December 22, 2022
• GetCoveredNJ | When Can I Buy Health Insurance? | Last accessed December 22, 2022
• HealthCare.gov | Health insurance plans & network types: HMOs, PPOs, and more | Last accessed December 22, 2022
• HealthCare.gov | The Marketplace in your state | Last accessed December 22, 2022
• HHS. gov | Who is eligible for Medicare? | Last accessed December 22, 2022
• KFF | Average Marketplace Premiums by Metal Tier, 2018-2021 | Last accessed December 22, 2022
• KFF | Health Insurance Coverage of the Total Population | Last accessed December 22, 2022
• Medicare.gov | Medicare Advantage Plans | Last accessed December 22, 2022
• NJ FamilyCare | Income Eligibility and Cost | Last accessed December 22, 2022
• NJ.gov | Claim Exemptions | Last accessed December 22, 2022
• NJ.gov | New Jersey’s Health Coverage Requirement | Last accessed December 22, 2022
• SHRM | 2021 FSA Contribution Cap Stays at $2,750, Other Limits Tick Up | Last accessed December 22, 2022
• Social Security | Apply for Benefits | Last accessed December 22, 2022
• State of New Jersey Department of Banking & Insurance | 2021 New Jersey Individual Health Benefits Plans and Rates | Last accessed December 22, 2022
• State of New Jersey Department of Banking & Insurance | Bulletin No. 18-12 | Last accessed December 22, 2022
• State of New Jersey Division of Aging Services | New Jersey Medicare Advantage Plans for 2021 | Last accessed December 22, 2022
• The Hartford | Personal Injury Protection (PIP) Car Insurance | Last accessed December 22, 2022