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.

Under the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, 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 in 2021, 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  purchased through the Marketplace. A benchmark plan is the second-lowest cost Silver plan in a consumer’s area that is used to calculate federal premium tax credits. Some 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. 

If you use advance payment of the premium tax credit to lower your monthly premium payment, you will have to “reconcile” those tax credits when you file your federal income taxes the following year using IRS Form 8962.

This means you will compare:

1. the amount of premium tax credit you used during the tax year to lower premiums and
2. the amount of premium tax credit you qualify for based on your final annual income for that year on your tax return.

The difference between these two numbers is what you may owe in your taxes if your income was higher than what you put on your application, or what you may be refunded if your income is lower than what you put on your application. You will get a 1095-A form from Get Covered New Jersey by January 31^st so you can fill out federal tax Form 8962.

People who qualify for a premium tax credit and have household incomes between 138% and 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.

Since 2021, New Jerseyans have had access to a state subsidy – called New Jersey Health Plan Savings (NJHPS) – that lowers the cost of health insurance.

New Jersey residents qualify for these savings based on income. New Jersey Health Plan Savings are available to eligible households with annual incomes up to 600% of the federal poverty level. In 2024, an individual with an income of up to $87,480 and a family of four who makes up to $180,000 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.

Medicaid program: If your income is at or below 138% of the federal poverty level ($1,677/month or $2,267 for a family of two), 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. Consumers eligible for NJ FamilyCare cannot get financial help with their coverage through GetCoveredNJ.

CHIP (Children’s Health Insurance Program): If your income is at or below 355% of the federal poverty level ($8,875/month for a family of four), then your Marketplace application may find that your children likely qualify for NJ FamilyCare, a publicly funded health insurance program for children with free or low cost coverage. Children eligible for NJ FamilyCare cannot get financial help with their coverage through GetCoveredNJ.