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Health Care
Open Enrollment for Marketplace Health Insurance Plans Extended to May 15, 2021
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The original window for uninsured New Jersey residents to enroll in a 2021 health insurance plan was November 1, 2020 to January 31, 2021, a period called “open enrollment.” On January 28, 2021, Governor Murphy announced that, due to COVID-19, open enrollment through the “Get Covered New Jersey” Marketplace would be extended until May 15, 2021. This decision followed the announcement by President Biden that open enrollment in the federal Marketplace, which closed on December 15, 2020, would be extended from February 15 through May 15, 2021.

Who should apply for Get Covered New Jersey?

If you or your child is uninsured, you should first determine whether you might be eligible for Medicaid or the Children’s Health Insurance Program (CHIP) through NJ FamilyCare. Adults age 19 to 65 are generally eligible for Medicaid if their income does not exceed 138% of the federal poverty level (FPL), which is $17,775 for a single individual in 2021. Children in New Jersey are generally eligible for CHIP up to 355% FPL ($94,075 for a family of four). Pregnant women are considered a household of two and are eligible with income up to 205% FPL. If you are eligible for a NJ FamilyCare program, it is better than buying a plan through Get Covered NJ because you will generally pay no premiums, deductibles, or co-pays to get care (children above 150% FPL have some small co-pays; those above 200% FPL have modest premiums).

If your income is too high for NJ FamilyCare, you should apply for a Get Covered NJ plan. If your income is between 139% and 400% FPL, you will be eligible for a subsidy to help you pay for your 2021 Marketplace plan. These subsidies are called advance premium tax credits. If your income does not exceed 250% FPL, you will be eligible for some cost-sharing reductions. Your deductibles, co-pays, and/or co-insurance will be discounted somewhat from what they would be at higher income levels. Income for both NJ FamilyCare and Get Covered NJ is calculated using the modified adjusted gross income (MAGI) method. Basically, the same method used to calculate income for a tax return (adjusted gross income) is used for these programs.

How do I apply for Get Covered NJ or NJ FamilyCare?

If you think your income exceeds NJ FamilyCare limits, you can apply for a Marketplace plan at Get Covered NJ. There, you can find out whether you qualify for subsidies; compare plan premiums, deductibles, and co-pays; and check whether your doctors are in the plan networks. Because choosing a plan that best fits your needs can be complicated and expensive, even with subsidies, you can also get help from organizations certified as assisters (or navigators). Local help is identified through the Get Help button on the website or you can call the Center for Family Services at 1-877-9-NAVIG8 (877-962-8448). 

If you enroll by April 30, your coverage will take effect May 1. If you enroll by May 15, your coverage will take effect June 1. If you apply after May 15, you are only eligible if you qualify for a special enrollment period (SEP). The most common way to qualify for a SEP is to be within 60 days of losing other health insurance coverage; for example, because you lost your job or your income increased above the NJ FamilyCare limit. (The extension of 2021 open enrollment from February 1 to May 15, 2021 is sometimes called the COVID-19 SEP.)

If you think you or your child might be eligible for NJ FamilyCare, you can apply online at NJ FamilyCare. You can also apply in person, by mail, or by phone at 1-800-701-0710. If you apply for NJ FamilyCare and you are above the income eligibility limit, your case should be transferred to Get Covered NJ. Unlike Marketplace plans, NJ FamilyCare has no limited enrollment periods; you can enroll at any time. It is also important to know that there is a moratorium on Medicaid terminations as long as the federal public health emergency from COVID-19 continues. This means that during this period, once you are enrolled in NJ FamilyCare, you remain eligible and cannot be legally terminated even if your income increases beyond the normal income limits. ​

3/31/2021