Get Covered New Jersey offers financial help to qualifying residents to help lower their monthly premiums and out-of-pocket expenses. In New Jersey, a family of four earning up to about $104,800 a year and an individual earning up to about $51,040 a year may qualify for financial help to lower their coverage costs.
If you buy a plan on the Marketplace, you may qualify for:
Eligibility for financial help is based on income, household size, and a few other factors.
Premium Tax Credits
Premium tax credits help lower your monthly premium payments. Eligibility for the premium tax credit is based on several things including income and household size. If your income is up to 400% of the federal poverty level for your household size, you may qualify for a premium tax credit.
Your premium tax credit amount is based on a sliding scale. Those with a lower income get a larger credit to help cover the cost of their insurance. You can apply some or all of your premium tax credit to your monthly insurance premium payment. The Marketplace will send your tax credit directly to your insurance company. You will pay less each month. This is called taking an “advance payment of the premium tax credit” or APTC.
Cost-Sharing Reductions (CSRs)
People who qualify for a premium tax credit and have household incomes 250% of the federal poverty level also qualify for CSRs. This is a discount that lowers the amount you pay for out-of-pocket costs such as deductibles, co-pays, and co-insurance. It means you pay less out of pocket each time you get medical care, including at the doctor’s office, hospital, or urgent care.
In the Marketplace, CSRs are often called “extra savings.” If you qualify for these extra savings, you get them only if you enroll in a health plan at the Silver level. When you shop for plans, look for the plan level: Bronze, Silver or Gold. You can use a premium tax credit for a plan at any level, but you will only get the extra CSRs if you choose a Silver plan. More information on plan levels is here.
If you qualify for CSRs, you also have a lower out-of-pocket maximum. Every time you pay out-of-pocket at the doctor’s office or for prescription drugs, those payments go towards your maximum. When you reach your maximum, your plan covers 100% of all covered services.
If you are a member of a federally recognized tribe or are an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may qualify for more CSR.
New Jersey Health Plan Savings
The NJ Health Plan Savings (NJHPS) will decrease the costs of premiums for current Marketplace enrollees and for new enrollees.
NJ residents will qualify for these new savings based on income. Individuals whose annual income is under 400% of the FPL will be qualified to get this additional financial help. It is projected that an individual up to 400% of the FPL ($51,040) may receive a flat rate of $564/year. While a family of four who makes up to $104,800 can receive up to a flat rate of $2,256/year in subsidy assistance to help lower the costs of their health insurance premium. Anyone who qualifies will be able to see a lower premium using our plan comparison tool or after filling out an application.
Learn more about New Jersey Health Plan Savings.
If your income is below 138% of the federal poverty level ($3,013/month for a family of four), then your Marketplace application may find that you likely qualify for NJ FamilyCare, a publicly funded health insurance program with free or low cost coverage.