Frequently Asked Questions

GetCoveredNJ is New Jersey’s official health insurance Marketplace where individuals and families can easily shop for and buy coverage. It is the only place you can apply for financial help to lower the cost of your monthly insurance premiums and out-of-pocket costs. You can learn if you might qualify for free or low-cost health insurance through NJ FamilyCare, New Jersey’s publicly funded health insurance program.

New Jersey employers can also find information on coverage for small businesses of up to 50 employees here.

GetCoveredNJ is a source of affordable health insurance for New Jersey residents who do not have health coverage from their employers or access to other health care programs. Financial help is available to help lower the cost of premiums and out-of-pocket costs for those who qualify. Residents can also learn at GetCoveredNJ if they might qualify for NJ FamilyCare, New Jersey’s publicly funded health insurance program.

 To shop on GetCoveredNJ you:

  • Must live in the United States and have a primary residence in New Jersey
  • Must be considered a resident of the United States and New Jersey for tax purposes
  • Must be a U.S. citizen or national. If you are a non-citizen, you must be lawfully present in the U.S. for the entire time you plan to have health coverage
  • Cannot be currently incarcerated

Individuals who are not eligible to buy health insurance through GetCoveredNJ can still apply for other members of their household who are eligible. For example, parents who are not lawfully present can still enroll their children in health insurance through GetCoveredNJ if their children are eligible.

The Open Enrollment Period is November 1 through January 31. It is once each year and is the only time you can enroll in coverage, unless you experience a major life event

If you have a life-changing event, you can buy health coverage without waiting for the yearly Open Enrollment. Certain events such as losing job-based coverage, having a baby or moving qualify you for a Special Enrollment Period (SEP).

If you qualify for an SEP, you usually have up to 60 days after the event to enroll in a plan. If you miss that 60 days, you have to wait until the next Open Enrollment to apply.

You may qualify for financial help to lower the cost of your plan. When you apply for health coverage through GetCoveredNJ, you could qualify for three types of financial assistance: premium tax credits, cost-sharing reductions and NJ Health Plan Savings, a new state subsidy offered by the state of New Jersey. Premium tax credits and the state subsidy help lower your monthly premium payments. Cost-sharing reductions help lower your out-of-pocket costs like deductibles and co-pays for doctor visits.

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 can qualify for financial assistance. In 2019, nearly 8 in 10 New Jerseyans on the Marketplace got a tax credit to help pay for their plan.

Visit our Financial Help page for more information.

You can apply for coverage and financial help:

Online: Apply at GetCovered.NJ.gov

In Person: Apply in person or by phone with free help from a certified assister or broker. To find a certified assister or broker in your area, go to Find Local Assistance.

By Telephone – Call our Customer Call Center. Calls are free.

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. 

You will need this information for yourself and anyone in your household applying for coverage:

  • Home and/or mailing addresses
  • Birth dates
  • Social Security numbers
  • Document information for legal immigrants, if applicable
  • Employer and income information for every member of your household (for example, pay stubs or W-2 forms)
  • Your best estimate of what your household income will be in 2021
  • Policy numbers for any current health plans covering members of your household

 

The income you report on your application is called your Modified Adjusted Gross Income (MAGI). In general, your MAGI is the estimated adjusted gross income (the income you report when you file your federal taxes) for your household plus any non-taxable Social Security, tax-exempt interest, or foreign income you have for the year for which you are applying.

For most people, a household consists of the tax filer, their spouse if they have one, and their tax dependents, including those who do not need coverage. The Marketplace counts estimated income of all household members. Marketplace savings are based on your expected household income for the year you want coverage, not last year’s income. You must make your best estimate so you qualify for the right amount of savings.

Remember: Report income changes to make sure you’re getting the right amount of Premium Tax Credit during the year. If the amount of advance credit payments you get for the year is less than the tax credit you should have received, you'll get the difference as a tax credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay some of the advance payments with your tax return. Learn more

Plans and prices change every year, so it is important to see what's new and compare. Use our plan comparison tool to see your choices for Marketplace coverage and health plans.

Open Enrollment is the yearly period when you can enroll in health insurance. In New Jersey, Open Enrollment for plan year 2021 is November 1, 2020 to January 31, 2021. It is the only time during the year when you can enroll in coverage, unless you have a major life event that qualifies you for a Special Enrollment Period or you qualify for NJ FamilyCare.

If you enroll by December 31, your coverage will start January 1. If you enroll in January, your coverage will start February 1.

If you qualify for a Special Enrollment Period due to significant life changes such as marriage, birth or adoption of a child, or loss of a job you can enroll in health insurance outside of Open Enrollment. You can enroll in NJ FamilyCare, the state’s publicly funded health insurance program, year-round. There is no limited enrollment period for NJ FamilyCare.

A Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for an SEP if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for an SEP, you usually have up to 60 days after the event to enroll in a plan. If you miss that 60 days, you have to wait until the next Open Enrollment to apply.

Yes. You can get free help to find a health insurance plan that’s right for you. Get Covered NJ has a network of trained professionals who can help people with enrollment for free. Call our Customer Call Center or find a certified assister or broker in your area who can guide you through the application beginning November 1, 2020.

Yes. New Jersey is committed to making sure health insurance is available and affordable to all residents. To help with this, the state has kept in place a requirement for New Jersey residents to have health coverage or make a shared responsibility payment during tax time, unless you qualify for an exemption.

Making sure all residents have health coverage helps make sure there are more health plans available for consumers to choose from. It makes sure premiums are affordable and comprehensive coverage is available for all who need it. Any funds the state collects from this penalty go to lowering the cost of health insurance for individuals.

Through New Jersey’s efforts to stabilize our insurance market, New Jerseyans can get needed coverage for themselves and their families. To learn more about New Jersey’s health insurance requirement and the shared responsibility payment, go to the State Treasury website.

Yes. In some cases, individuals who do not have minimum essential coverage will not have to make the shared responsibility payment. These are called “exemptions.” To learn more about applying for a hardship exemption, go to the State Treasury website. If you get a hardship exemption, you will also be able to enroll in a Catastrophic plan that has lower premiums but with higher costs for care.

All plans sold on GetCoveredNJ have met the high standards of GetCoveredNJ, the New Jersey Department of Banking and Insurance (DOBI), and the requirements of the Affordable Care Act. Each plan sold on GetCoveredNJ covers essential health benefits (EHBs). The amount you pay for these services varies by plan. These benefits include:

  • Ambulatory care (outpatient) services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services, including annual physicals and mammograms
  • Chronic disease management
  • Pediatric services

Some routine and preventive care is required to be free to you. This includes certain vaccinations (shots) and child well visits.

No. A pre-existing condition will not keep you from getting health coverage. An insurance company can’t turn you down or charge you more because of your condition. Once you have insurance, the plan can’t refuse to cover treatment for pre-existing conditions. 

It depends. Each insurance company has a network of doctors in each plan. Plans do not provide coverage for doctors who are not in their network. You can find if a doctor is in the plan you want to buy when you compare plans on GetCoveredNJ.

Where you live can affect your eligibility for health coverage and cost-savings through GetCoveredNJ. Generally, people must live in a state to be considered residents. But if someone is living out of the state temporarily, they can still be considered a resident of the state. To qualify for coverage through GetCoveredNJ, you must have a New Jersey address that is used for tax purposes and that is considered the permanent home address where everyone on your application lives.

Plans in the Marketplace are in “metal” categories: Bronze, Silver, Gold, and Platinum. Metal categories are based on how you and your plan split the costs of your health care. There are also Catastrophic health plans. Right now, there are no Platinum plans offered in the Marketplace.

  • Bronze: The health plan pays 60% of total health care costs. You pay about 40%. Bronze plans have the lowest premiums and the highest levels of cost-sharing (deductibles, co-pays, etc.).
  • Silver: The health plan pays 70% of total health care costs. You pay about 30%. People who qualify for premium tax credits may also qualify for more savings through cost-sharing reductions. These can only be applied to Silver plans.
  • Gold: The health plan pays 80% of total health care costs. You pay about 20%. Gold plans have higher premiums and lower cost-sharing levels.
  • Platinum: The health plan pays 90% of total health care costs. You pay about 10%. Platinum plans have the highest premiums and the lowest levels of cost-sharing.
  • Catastrophic: Available to individuals under the age of 30 and those who qualify for a hardship exemption. This plan has a low monthly premium, but a very high deductible. This may be an affordable way to protect yourself from costs of a serious illness or injury. But you pay most routine medical expenses yourself.

Short-Term Limited Duration plans are prohibited in New Jersey. Sometimes called "skimpy" plans, they don't cover the basic services you would expect from insurance and that are required in New Jersey. Plans offered at GetCoveredNJ cover comprehensive benefits like preventive care, check-ups, prescriptions, hospitalizations, maternity care, mental health care, and more.

It depends. Under the Affordable Care Act, dental coverage is treated differently for adults and children 18 and under. Dental coverage for children is an essential health benefit. If you buy coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan. You do not have to buy it.

Dental coverage for adults 19 and older is not an essential health benefit. Health insurance companies do not have to cover adult dental care. You can shop for and buy dental plans separately from your health plan at GetCoveredNJ. Compare plans and costs with the plan comparison tool

The Affordable Care Act allows children to be added to or kept on a parent's health insurance policy until they turn 26 years old. These rules apply to job-based insurance coverage and to individual plans. Children can join or stay on a parent's plan even if they are:

  • Married
  • Not living with their parents
  • Attending school
  • Not financially dependent on their parents
  • Eligible to enroll in their employer’s plan

If you buy an individual plan and your adult children under age 26 are your dependents for tax purposes, you can add them to your plan. The same is true if the adult children are not dependents and you are not applying for assistance to pay for your coverage.

If an adult child is not a dependent and anyone on the application is applying for tax credits, the child should fill out his or her own application to apply for a tax credit. They can choose the same plan but will be on a different policy. 

The same rules apply for all tax dependents. For example, children who claim their parents as tax dependents on their tax return follow these same rules.

Yes. You will not qualify for the premium tax credit if your employer is offering coverage that meets specific plan rules and certain rules for being affordable. Check with your employer and a GetCoveredNJ certified assister or broker to make sure you have all the information you need before buying a plan.

If you have coverage now through HealthCare.gov, you can access your new account starting on November 1, 2020 at Existing Marketplace Customers

If you don’t have coverage or are shopping for Marketplace coverage for the first time, you can go to New Customers

You can find trained experts to help you shop and enroll at Find Local Assistance or go to Customer Service.

Get Covered New Jersey is working with HealthCare.gov to get your information to GetCoveredNJ. Starting November 1, 2020, you can learn how to access your new account at Existing Marketplace Customers.

If you got a letter with an access code, you can access your account and current coverage information starting November 1, 2020. For more information, go to Existing Marketplace Customers.

Once you’ve applied, you can learn more about how to use your coverage and update your information if you have a change during the year at After You Apply.

After you apply for and enroll in coverage, it is important that you can use it to get health care. If you believe a decision your health plan made is wrong and is negatively affecting your access to care, you can file a complaint with the New Jersey Department of Banking and Insurance. You can file an online complaint. Or call the Consumer Hotline 1-800-446-7467, from 8:30 a.m. to 5:00 p.m. EST Monday through Friday.

If anyone in your household had a Marketplace plan in 2020 through HealthCare.gov, you should get Form 1095-A, Health Insurance Marketplace Statement by mail in early 2021.

  • Your 1095-A has information about Marketplace plans anyone in your household had in 2020.
  • It comes from the HealthCare.gov, not the IRS.
  • Keep your 1095-As with your important tax information, W-2 forms, and other records.

To learn more about your 1095-A form and contacting HealthCare.gov, go to https://www.healthcare.gov/tax-form-1095/#find-1095-a.


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