The first option is to apply for Medicaid, which has no premiums, deductibles, or co-pays. In New Jersey, Medicaid is part of the NJ FamilyCare program. You may be eligible for Medicaid even if your household is receiving some income. Income eligibility for adults is 138% of the Federal Poverty Level (FPL), which is currently $17,609 for a single individual. See Applying for NJ FamilyCare for full 2020 eligibility tables. Countable income is based on the MAGI method, which is explained in Medicaid Eligibility and the Modified Adjusted Gross Income (MAGI) Method of Calculating Income. If you are receiving unemployment benefits, the gross amount of your regular NJ unemployment benefits is counted as income, but the $600 weekly federal Pandemic Unemployment Compensation payment is not included in the calculation.
You can apply for Medicaid at any time. You can use the online application found at the NJ FamilyCare website. Your application usually takes 30 days or less to process, but the sooner you apply, the sooner your coverage will start. Coverage will be retroactive to the first of the month that you applied.
If your household income is too high for NJ FamilyCare, it may still be low enough to qualify for a subsidized policy through the federal marketplace. Although this is coverage that you pay for, it is more affordable than if you have to pay the full cost of a policy. The application can be done online, at Healthcare.gov or at Get Covered New Jersey. If you want to be considered for a subsidy, you must answer “yes” to the question about whether you plan to file a federal tax return for 2020. (You can file a return even if you don’t owe taxes.) Plans are offered on “Bronze, Silver, Gold, Platinum” levels. The Silver level plans are best for persons below 250% FPL because deductibles and co-pays are reduced. If you need assistance with your application or figuring out the best plan for your situation, the navigators at Center for Family Services (877-962-8448) can be very helpful.
The marketplace has some important timelines to keep in mind. You only have 60 days of a “special enrollment period”, starting the day after your employer-based coverage ends, to file an application. If you apply by the 15th day of a month, your coverage will be effective on the first day of the following month. Beware: if you elect COBRA coverage under your former employer’s plan, you are not able to apply for coverage on the marketplace until the 2021 open enrollment period in November.
Children in the household may be able to obtain coverage through NJ FamilyCare when the adults in the household cannot, due to the different income caps. The household income limits for the coverage for children are much higher than for adults. Although this coverage sometimes includes a premium and co-pays, these have been waived during the pandemic emergency. Different types of coverage can be combined in a household, so that the children may be covered by a NJ FamilyCare plan while the adults are covered by a plan purchased through the federal marketplace.
If you have any questions about what coverage you might be eligible for, or you think you have been unfairly denied coverage, the Health Care Access Project may be able to assist you. Call the LSNJ hotline at 1-888-576-5529 (1-888-LSNJ-LAW) or submit an online web intake.
This information last reviewed: Jun 8, 2020