Under the Affordable Care Act (ACA), each state had a choice whether to establish its own health insurance marketplace (also called an “exchange”) or to direct its residents to the federal marketplace. Under Governor Chris Christie, New Jersey chose to participate in the federal marketplace (Healthcare.gov), but under Governor Phil Murphy, New Jersey changed course and has now established its own state marketplace (called “Get Covered New Jersey”), which opens on November 1, 2020 for enrollment in 2021 health insurance plans.
Having its own marketplace will give New Jersey residents some advantages. For example:
- The “open enrollment” period to sign up for 2021 plans will be twice as long, extending from November 1, 2020 to January 31, 2021 (enrollment through the federal marketplace ends on December 15, 2020).
- If your income decreases or increases during the year, it will be easier to transition between the state marketplace and New Jersey’s Medicaid programs that operate as part of NJ FamilyCare.
- It will allow New Jersey to more easily offer additional financial assistance to New Jersey residents who have trouble affording the costs of marketplace plans.
What are the income limits for NJ FamilyCare and subsidized Get Covered New Jersey plans?
New Jersey residents may receive health insurance either free or at reduced cost depending on their income. Adults age 19-64 with income that does not exceed 138% of the Federal Poverty Level (FPL) are eligible for free health insurance through NJ FamilyCare. They will pay no premiums or cost-sharing. (Cost-sharing is the term used to describe health care costs in addition to premiums that an individual with insurance is required to pay, such as deductibles, co-pays, or co-insurance.) Adults with income between 139-400% FPL are eligible for federally subsidized premiums to buy marketplace policies. These individuals will now also be eligible for additional state financial assistance through Get Covered New Jersey to help with premiums. Those with income between 139-250% are also eligible for federal financial assistance that reduces the cost-sharing they are required to pay.
Children with income up to 147% are eligible for NJ Family Care Plan A with no premiums or cost-sharing. Children with income between 147-355% FPL are eligible for NJ FamilyCare Plans B, C, or D, with either no-cost or reduced-cost premiums and cost-sharing, depending on where their income falls in that range. Pregnant women are eligible for NJ FamilyCare with income up to 205% FPL (with their unborn child counting as part of family size). Pregnant women and children ineligible for NJ Family Care are eligible for financial assistance through Get Covered NJ based on the income limits described above.
2020 Eligibility for Health Insurance Financial Assistance
Adults Age 19-64
Income Limit for
NJ FamilyCare (138% FPL)
Get Covered NJ
Income Limit for
Get Covered NJ (250% FPL)
How is income calculated?
Both NJ FamilyCare and Get Covered NJ use the same method for calculating income. It is called modified adjusted gross income or MAGI. With a few exceptions, it is the same method that is used to calculate adjusted gross income (AGI) on the federal income tax return. Generally, only taxable income is counted when calculating eligibility for these programs. For example, child support is not taxable income, so it would not be counted. Similarly, payments you make that are deductible to arrive at AGI, such as contributions to retirement plans like IRAs, are deductible in calculating your MAGI.
How much financial assistance will I be eligible for through Get Covered NJ?
Premium subsidies, referred to as advance premium tax credits (APTC), are available on a sliding scale based on where your income falls between 139-400%. For example, if your income is 150% FPL, your APTC is calculated so that you would pay 4.14% of your income for the premium of the second lowest premium “Silver” plan. (Plans are organized based on cost as Bronze, Silver, Gold, or Platinum plans.) If your income is 300-400% FPL, your APTC is calculated so you would pay a higher percentage of your income (9.83%) for the premium of that same plan.
Because New Jersey now has its own marketplace, you will get more help paying your premium. This new subsidy is called New Jersey Health Plan Savings (NJHPS). It is projected that this NJHPS amount in 2021 will be at least $564 per person in 2021, so a couple would receive at least $1,128 in additional subsidy.
People with income up to 250% FPL will also receive cost-sharing reductions (CSR). To be eligible for this CSR, you would have to purchase a Silver plan. People who select a Silver plan will automatically receive the CSR. The amount of reduction depends on your income level. For example, a Silver plan without a CSR may have a deductible of $7,150. If your income is between 201-250%, the CSR would reduce the deductible to $4,500. If your income is between 151-200%, the CSR would reduce the deductible to $800. If your income is 150% or lower, the deductible would be reduced to $250.
How Do I Apply for Get Covered NJ?
If your income is between 138-400% FPL, you can get financial assistance by applying for health insurance through the new New Jersey marketplace at Get Covered NJ (from the State of New Jersey). If your income is above 400% FPL, you can still purchase a policy through this website, but you will not get financial assistance. If your income is at or below 138% FPL, you can apply for health insurance through NJ FamilyCare. These two programs work together and should transfer your application to the right place if you apply to the wrong one. If you don’t want to apply online, you should be able to apply for both programs by phone or by mail.
Also on the Get Covered NJ website, you can compare plans and prices before you apply, so you have an idea how much financial assistance you will get and what different plans cover. You will find contact information for a list of organizations that can help you apply and enroll in a plan, such as the Center for Family Services, which operates statewide. If you are currently enrolled in a marketplace plan through Healthcare.gov, you will find information about transitioning to coverage through Get Covered NJ. There is also a list of frequently asked questions (FAQs).
What if I still need health insurance coverage for 2020?
If your income is too high for NJ FamilyCare, you will only be able to purchase coverage for the remaining months of 2020 if you qualify for a Special Enrollment Period (SEP). A SEP is triggered by a specific event and it usually means that a person has 60 days from the triggering event to purchase a marketplace plan. The most common triggering event is losing other health insurance. For example, if you lost your health insurance on October 1, 2020, because you were laid off from your job, you would have until November 30, 2020, to purchase a plan from the marketplace. If you select a plan by November 15, 2020, you could have coverage effective December 1, 2020, because this coverage is still in 2020. However, you would have to apply through the federal marketplace at Healthcare.gov, rather than through Get Covered NJ, which is only available for 2021 plans.