Get Financial Help

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. 

Remember:

Changes in income or household size may lower or raise your premium tax credit. Your tax credit amount is based on the income you think you are going to make in the coming year. It also changes based on how many people are in your household. When you file your taxes for 2021, you will need to report the amount of premium tax credit you used. If your income or household size changes during 2021, you may owe back part of the premium tax credit. Or you may get more premium tax credit.

If your income or household size during the year is not what you put on your application, it is important to update your application on GetCoveredNJ right away. This is to make sure your premium tax credit is correct.

If your income goes up or you lose a household member, you will probably qualify for less premium tax credit. If you think your income might go up or your household size may go down, you can lower the tax credit amount you take in advance each month. You can do this at the end of the GetCoveredNJ enrollment process. This will help make sure you do not owe back any of the tax credits you took in advance for health premiums.

If your income goes down or you gain a household member, you will probably qualify for more premium tax credit. If you have these changes, update your application to find out if your premium tax credit goes up.

If at the end of the year you have taken more advance payments of the premium tax credit (APTC) than you qualify for, you may have to pay money back when you file your federal income tax return. This is called “reconciling” your APTC with the actual premium tax credit you qualify for based on your final 2021 income.

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 this year, New Jerseyans will have access to a state subsidy – called New Jersey Health Plan Savings (NJHPS) – that will lower the cost of health insurance.

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.

NJ FamilyCare

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.

Plan Comparison Tool 2021

Use our Plan Comparison Tool to compare plans and estimate how much financial help you may qualify for before you start your Marketplace application.

Why shop for health insurance on GetCoveredNJ?

GetCoveredNJ is the only place where you can apply for financial help to lower the cost of your monthly premiums and out-of-pocket costs for health insurance.  Open Enrollment starts November 1, 2020. You can browse health plans starting in mid-October.


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