Get Covered New Jersey offers financial help to qualifying residents to help lower their monthly premiums and out-of-pocket expenses. Due to the American Rescue Plan Act, Get Covered New Jersey customers are now eligible for new and expanded financial help. The State of New Jersey and the federal government are now providing additional savings. This means more people now qualify for more financial help.
If you did not qualify for financial help before because your income was too high, you may qualify under the recent changes. If you already receive financial help, you are likely eligible for additional premium reductions. These new changes make coverage more affordable at all income levels.
If you buy a plan on the Marketplace, you may qualify for:
- Premium Tax Credits *New and expanded in April 2021
- Cost-sharing reductions
- New Jersey Health Plan Savings *New and expanded in April 2021
Eligibility for financial help is based on income, household size, and a few other factors.
You should use the GetCoveredNJ Shop and Compare Tool to see if your premiums will be lower due to the new financial help.
Premium Tax Credits
Under the new changes, more people now qualify for more financial help. Previously, premium tax credits were only available up to certain income levels ($51,040 for an individual or $104,800 for a family of four). Effective May 1 or after, there are no longer income limits for consumers to qualify for financial help through Get Covered New Jersey.
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. Premium tax credits will apply at every income level to ensure that no household pays more than 8.5% of income for a benchmark plan (the second-lowest cost Silver plan in a consumer’s area that is used to calculate federal premiums tax credits) purchased through the Marketplace. Many households will qualify for nearly free coverage.
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
For the first time in 2021, New Jerseyans will have access to a state subsidy – called New Jersey Health Plan Savings (NJHPS) – that will lower the cost of health insurance. Effective May 1, the State of New Jersey will provide new and expanded financial help to further lower premium costs.
New Jersey residents will qualify for these new savings based on income. Households with annual incomes up to 600% of the FPL will receive the new and expanded NJHPS. An individual with an income of up to $76,560 and a family of four who makes up to $157,200 can receive state subsidies to lower the costs of health coverage. 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.