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Health Care
Open Enrollment Period for Marketplace Health Insurance Ended, but You Still can Enroll with SEP

“Open enrollment” to buy private health insurance for 2018 through the Federal Marketplace (www.healthcare.gov) ended on December 15, 2017. If you already had a Marketplace policy, November 1- December 15 was also the time to re-enroll or change plans. All states like New Jersey that use the Federal Marketplace had this limited open enrollment period for 2018.

What if I missed the open enrollment period?

After December 15, 2017, the only way you will be able to qualify for a Marketplace plan for 2018 is if you qualify for a Special Enrollment Period (SEP). An SEP is triggered by a specific event and you usually have 60 days from the triggering event to apply for coverage through the Marketplace. The most common event triggering an SEP is loss of other health coverage. For example, if you have health insurance coverage through your job, but lose that coverage on February 1, 2018, you could still enroll in a 2018 Marketplace plan even though open enrollment for 2018 has closed. This is because you would qualify for an SEP as long as you enroll within 60 days of February 1 (by April 1, 2018). Keep in mind that if you want coverage by the first of a month, you need to enroll by the 15th of the prior month. (If you want coverage by March 1st, you have to enroll by February 15th.)

This applies if you are laid off, quit your job, or have a reduction in hours that makes you no longer eligible for your plan at work. This also applies if you lose employer coverage through divorce, legal separation from, or death of your spouse. You also qualify for an SEP if your employer continuation coverage (such as COBRA) expires, if your student health plan expires, or if you lose coverage under your parent’s plan because you turned 26 or 30. A person who is currently receiving NJ FamilyCare and is terminated because of an increase in income or some other change also qualifies for an SEP.

Other examples of events triggering SEPs are:

  • If you are released from prison or jail
  • If the contribution you have to pay for your health plan at work is increased above a certain level
  • If you newly gain status as a citizen or lawfully present immigrant
  • If you get married
  • If you adopt a child
  • If you move from another state to New Jersey

Buying health insurance can be very expensive. For example, a 62-year-old single person in New Jersey would have to pay approximately $893 per month to get a plan with a $900 deductible and $15 co-pays for generic prescription drugs. Under the ACA, however, persons with low and moderate income can receive financial assistance, so that the same plan for a person with $18,000 annual income would cost $195 per month with a $0 deductible and $5 co-pays for generic prescription drugs. This premium may still be hard to afford, but it is much better than without assistance. Premium subsidies, referred to as Advance Premium Tax Credits (APTC), are available on a sliding scale based on income up to 400% FPL. You can also look for different Marketplace plans that have lower premiums, but higher deductibles and co-pays, and get help with a Cost Sharing Reduction (CSR) for Silver Plans. CSRs are available up to 250% FPL.

Household
Size
Annual Limit for Premium Subsidies
(APTC) on the Marketplace
Annual Limit for Cost Sharing Reductions
(CSR) on the Marketplace

1

$ 48,560

$ 30,350

2

$ 65,840

$ 41,150

3

$ 83,120

$ 51,950

4

$ 100,400

$ 62,750

How is income calculated?

To determine eligibility for Marketplace financial assistance, Medicaid, and CHIP, one method for counting income is used. It is called the Modified Adjusted Gross Income or “MAGI” methodology. With a few exceptions, it is the same method that is used to calculate Adjusted Gross Income (AGI) on a federal income tax return. Generally, only household income that is taxable is counted as income in determining eligibility for these programs. For example, SSI and child support are not counted as income because they are not taxable. You can also subtract amounts that you contribute to retirement plans like IRAs because they are deductible when determining AGI.

How do I apply for coverage through the Marketplace?

You can apply for a Marketplace plan online at www.healthcare.gov or by calling 1-800-318-2596. If you want in-person assistance, go to the Find Local Help section on the healthcare.gov website and enter your zip code or contact one of the agencies below for help.

Center for Family Services
Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, and Salem Counties
1-877-9-ACCESS (1-877-922-2377)

Jewish Renaissance Medical Center
Union and Essex Counties
(973) 564-1415 (Newark)
(732) 347-8095 (Perth Amboy)

The Family Resource Network, Inc.
Hunterdon, Mercer, Morris, Ocean, and Somerset Counties
(800) 355-0271

The Food Bank of Monmouth and Ocean Counties
(732) 643-5888

In addition, New Jersey’s Federally Qualified Health Centers (FQHC) provide free enrollment assistance by certified application counselors. See Locate a Health Center (from New Jersey Primary Care Associates) for a list of centers.

Eligibility for NJ FamilyCare

If you did not enroll for insurance through the Marketplace, you should check whether you and your family members are eligible for NJ FamilyCare. If you enroll in NJ FamilyCare, you will probably not have to pay a premium, deductible, or co-pay.

Under the Affordable Care Act (ACA), many new people became eligible for Medicaid (called NJ FamilyCare in New Jersey). New Jersey adults age 19 to 65 are now eligible for Medicaid if their household income is at or below 138% of the Federal Poverty Level (FPL).

MEDICAID ELIGIBILITY FOR ADULTS FOR 2018


Household
Size
Annual Income Limit for
Adult Medicaid (138% FPL)
Monthly Income Limit for
Adult Medicaid (138% FPL)

1

$ 16,754

$ 1,396

2

$ 22,715

$ 1,893

3

$ 28,667

$ 2,389

4

$ 34,638

$ 2,887

NJ FamilyCare for children includes both Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid and CHIP have different income limits and different coverage plans, but both fall within the NJ FamilyCare program.

The Medicaid income limit for children is 147% FPL. Children eligible for Medicaid get Plan A. Children above that income limit up to 355% FPL are eligible for the Children’s Health Insurance Program (CHIP). Depending on their income, children eligible for CHIP get Plan B, C, or D and might have to pay a higher portion of the cost. Children over 150% FPL have to pay small co-pays, and children over 200% FPL have to pay a small premium.

MEDICAID AND CHIP ELIGIBILITY FOR CHILDREN FOR 2018


Household Size
Annual Income Limit for Child Medicaid
Annual Income Limit for CHIP Coverage

1

$ 17,846

$ 43,097

2

$ 24,197

$ 58,433

3

$ 30,547

$ 73,769

4

$ 36,897

$ 89,105

How do I apply for NJ FamilyCare?

If you think your income is low enough to qualify for NJ FamilyCare, apply online at njfamilycare.org or call 1-800-701-0710. In addition to NJ FamilyCare programs based on your income, there are also Medicaid programs within NJ FamilyCare for persons based on disability or age (over 65). You can apply in person for all Medicaid programs whether based on income, disability, or age by going to your county Board of Social Services. See County Welfare Agencies (Boards of Social Services) (from NJ Department of Human Services) for more information.

You can sign up for NJ FamilyCare at any time. There is no limited enrollment period. ​​​

3/5/2018