Frequently Asked Questions

Get Covered New Jersey is the state'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.

Get Covered New Jersey 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 Get Covered New Jersey (abbreviated as 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 (see here)
  • 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.

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.

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 New Jersey Health Plan Savings, a 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.

Due to the federal American Rescue Plan Act signed on March 11, 2021, Get Covered New Jersey customers may now be eligible to receive expanded financial help. The State of New Jersey and the federal government are providing additional savings through subsidies and advanced premium tax credits. This means more people now qualify for more financial help.

Visit our Financial Help page for more information.

You can enter some basic information into the shop and compare tool to receive an estimate of how much financial help you could receive. For a final determination, you will need to complete a full application and provide more detailed information about your household and income. After completing an application, you will receive official eligibility results that tell you how much financial help you qualify for.

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.

By U.S. Mail - Download an application and mail to:

Get Covered New Jersey
Attn: Application
PO Box 55898
Trenton, NJ 08638

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. 

Plans and prices change every year, and new financial help became available to residents at more income levels in May 2021. That means many people who previously did not qualify for financial help may now be eligible to save on a health plan through Get Covered New Jersey. It is important to see what's new and compare. Use our shop and compare tool to see your choices for Marketplace coverage and health plans.

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

  • Home address and mailing addresses, if different
  • Birth dates
  • Social Security numbers
  • Document information for lawfully present immigrants and non-citizens, if applicable
  • Employer and income information for every member of your household (for example, pay stubs, previous year tax filing, or W-2 forms)
  • Your best estimate of what your tax household income will be for the year you are seeking coverage
  • Policy numbers for any current health plans covering members of your household

You should only list people in your tax household. Your tax household is all of the people who you will include on your federal income tax return for the year you receive coverage, even if they are not seeking coverage.

What is my tax household?

Tax filer + spouse + tax dependents = tax household

Follow these basic rules when including members of your household:

    • Include your spouse if you’re legally married.
    • If you plan to claim someone as a tax dependent for the year you want coverage, include them on your application.
    • If you won’t claim them as a tax dependent, do not include them.
    • Include your spouse and tax dependents even if they are not seeking health coverage.

Your tax household includes the tax filer and spouse, if you have one, and your dependents that are included on the tax return. Generally, one’s tax dependents are their minor children or people who live with them and depend on them for support. The IRS (at irs.gov - https://www.irs.gov/publications/p501) defines who can be a tax dependent and tax professionals can assist with this determination of who is your tax dependent and should be included in your GetCoveredNJ application.

Other persons who live with you but who are not your spouse and are not your tax dependents should not be included on your GetCoveredNJ application. Anyone who files a separate tax return because they are not claimed as a tax dependent should file their own separate GetCoveredNJ application. Friends and family members who happen to live in the same house with you but are not your tax dependents, such as your working adult children, your working siblings, your parents, or your friends, should be filing their own GetCoveredNJ application. However, if you will claim any of these people as your tax dependents for the coverage year’s tax return, then they should be included in your GetCoveredNJ application.

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 before tax (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 tax household members (not everyone who you live with). 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 within 30 days 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

The application will ask you for information about how much you earn through employment and other sources, including social security benefits, alimony, tax-exempt interest, and tax exempt foreign income. Review each question carefully on the application and provide complete details for each type of income and deduction. The application will use the information you provide to calculate an estimated income for the coverage year.

Think about whether you are expecting changes, including raises, new job or job loss, changes to other sources of income, and gaining or losing a tax dependent. If you are expecting a change in income, then you can enter that in the application instead of what the system calculates for you.

Remember to come back and update your application throughout the year if you have income or household changes to make sure you get the right amount of financial help.

You should only count your deductions from your federal income tax filing (Form 1040 Schedule 1) such as: deductible part of self-employment tax, IRA deduction for contributions if you don’t have a retirement account through your job, educator expenses if you are a teacher and personally pay for teaching supplies, alimony paid if your divorce was finalized before 1/1/19, and student loan interest deduction (note: principal payments on a student loan do NOT count as a deduction, only the interest paid can count as a deduction). Personal expenses also do NOT count as deductions. The standard deduction, itemized deductions and qualified business income deduction are also not included on your application as they are not part of your adjusted gross income. Follow the prompts in the application for this information.

Foreign earned income that was excluded from taxes must be included on your application for financial help (premium tax credits). U.S. citizens or resident aliens of the United States who lived abroad may qualify to exclude foreign earnings from income taxes up to a certain amount ($107,600 for 2020, and $108,700 for 2021). In addition, some foreign housing amounts may be excluded from taxes. Contact a tax professional if you have questions about untaxed foreign income to include in your application. Untaxed foreign income must be added to your GetCoveredNJ application when entering your income information.

  • Applicants who are eligible to buy coverage with financial help:
    U.S. Citizen / Naturalized U.S. Citizen / U.S. National, Lawful Permanent Resident​, Pending I-551 (When consumer gets Employment Authorization Cards (EAD)), or Temp. I-551, Non-immigrant Visa holders (Only who can legally work in the U.S. and file taxes), Temporary Protected Status (TPS)​, Asylees, Refugees, Deferred Action, Granted relief under the Convention Against Torture (CAT)​, citizens of Micronesia, the Marshall Islands, and Palau; and others

  • Applicants who are eligible to buy coverage without financial help​:
    • Certain non-immigrant visa holders (e.g., student visa, B1/B2 visa, etc.)
    • If F1 visa holders granted Pre or Post Optional Practical Training (OPT) with valid Employment Authorization Card (work authorization), they may be eligible for financial help

  • Applicants who CANNOT buy coverage through marketplace:
    Deferred Actions for Childhood Arrival (DACA), Undocumented Immigrants (May be eligible for Emergency Medicaid depending on situation), Non-New Jersey residents
    (DACA recipients and undocumented immigrants may purchase coverage directly from an insurance company.)

  • Consumers with eligible immigration statuses who have household incomes below 138 percent of the FPL and are ineligible for NJ FamilyCare due to immigration status are eligible for coverage and financial help through GetCoveredNJ even if their income falls below 100 percent of the FPL.

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.

If you don’t agree with a Marketplace decision, you may be able to file an appeal. You generally have 90 days from the date of your Eligibility Determination Notice to ask for an appeal.

Marketplace decisions you can appeal:

  • Not eligible for advance payments of the premium tax credit (APTC)
  • Eligible for APTC, but the amount is wrong
  • Not eligible for a Special Enrollment Period
  • Not eligible to buy a Marketplace plan
  • Not eligible to choose a Catastrophic plan

You cannot file an appeal until you get the Eligibility Determination Notice. It is a letter that says your eligibility for coverage has ended or your savings have changed. The letter will also explain your appeal rights.

Appeal Form

 

Get Covered New Jersey worked with HealthCare.gov to get your information to GetCoveredNJ. 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. For more information, go to Existing Marketplace Customers.

You should have received a letter or email from Get Covered New Jersey (or from noreply@getcovered.nj.gov) with an access code to log in to your new user account. If you did not receive the email, please check your spam folder. For more information, go to the Existing Marketplace Customers page.

Open Enrollment is the yearly period when you can enroll in health insurance. In New Jersey, Open Enrollment is November 1 to January 31. Open Enrollment is the only time during the year when you can enroll in coverage, unless you experience a major life event that qualifies you for a Special Enrollment Period, if a state-designated Special Enrollment Period is in effect, or if 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. Open Enrollment ends January 31st.

A Special Enrollment Period (SEP) is a time outside of the yearly Open Enrollment Period when you can sign up for health insurance coverage or make changes to your existing enrollment. You qualify for a SEP if you have had a qualifying life event.

The state may also designate a Special Enrollment Period in response to the needs of its residents.

A qualifying life event (QLE) is a specific event that qualifies you for a SEP. Qualifying Life Events include:

  • Birth, Adoption or Court-ordered dependent
  • Change in legal presence, incarceration, American Indian/Alaskan native status
  • Loss of coverage through employer, Medicaid or the Children’s Health Insurance Plan (known as NJ FamilyCare), or other minimum essential coverage
  • Marriage
  • Moved into State
  • Pregnancy
  • Primary individual on the application died or became incarcerated
  • Survivor of domestic violence, abuse or spousal abandonment
  • Exceptional Circumstances or Plan/Program Error
    • Plan or benefit display error
    • Error, misrepresentation, inaction or misconduct by the Exchange or assisters
    • Health plan violation of a material policy provision
    • Resolving a data matching issue proving eligibility
    • Exceptional circumstances that reasonably prevented enrollment, including serious medical conditions, natural disasters, etc.

More information is available here.

If you had a qualifying life event, you should report the event, apply for health insurance, and enroll in a plan within 60 days from the event. If you or someone receiving coverage has a change in income or gain other minimum essential coverage (MEC) during the year, you should report these changes within 30 days by updating your application.

If you have a yearly income up to 200% of the Federal Poverty Level (FPL), or $25,760 for an individual and $53,000 for a family of 4, you can apply for coverage any time during the year and may qualify for plans with a zero dollar or low cost monthly premium under the Expanded Access Special Enrollment Period.  

Gaining other health insurance coverage (such as Medicare, employer coverage, etc.) should be reported the month before their new coverage begins by updating your application to avoid a gap in coverage for other household members. Some household enrollees may need to select a new health plan if the head of household is gaining other coverage.

You must live in New Jersey to be eligible for coverage through GetCoveredNJ. If you move to the state of New Jersey, you can apply for coverage and if eligible, enroll through a Special Enrollment Period to start your new coverage when your other coverage ends. You should enroll in a plan where you reside and file taxes.

Generally, if you are enrolled or eligible for other minimum essential coverage, you will not qualify to get financial help from Get Covered New Jersey.

Yes. You can get free help to find a health insurance plan that’s right for you. GetCoveredNJ 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.

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.

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.

Your health plan will send you a membership package. It will have enrollment materials and a health insurance card. The card is your proof of insurance. It may take a few days after you apply through GetCoveredNJ for your health plan to send your card, especially in busy times like Open Enrollment.

If you don’t get your card, call your health plan. Ask if they sent your card. Ask if your coverage is active. Health plan member services numbers are listed on their websites. Or go to this list of insurance companies and their customer service phone numbers. You can also check your health insurance coverage status under your enrollment status or call the GetCoveredNJ call center.

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 shop and compare 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.

If an adult child is not a tax dependent, the adult 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.

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.

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.

You may challenge coverage denials by a health insurance company. Coverage required on an emergency or urgent basis require a decision within 48 hours.

Other types of denials may also be challenged. These include utilization management (UM) denials. UM denials are refusals to pay a claim or authorize a service or supply because the insurance company determined it is:

  • not medically necessary to treat the covered person’s illness or injury,
  • experimental or investigational,
  • cosmetic, or
  • dental rather than medical.

Two other types of UM decisions that may also be challenged:

  1. Denial of an “in-plan exception” (a request to get services from an out-of-network provider when the insurance company’s network does not have any providers who are qualified, accessible, and available to perform the specific medically necessary service), and services are required on an emergency or urgent basis.
  2. Administrative denials, such as refusal to pay a claim or authorize a service or supply based on contract provisions or other grounds not involving the exercise of medical judgment.

To learn more, go to: https://www.nj.gov/dobi/division_insurance/managedcare/ihcap.htm.

Health care providers are not allowed to “balance bill” for certain surprise services, such as in an emergency, or when an in-network provider was not available in an in-network hospital. Under state law, doctors and hospitals may not bill you above the amount of your in-network cost-sharing, including your deductible, co-pays, or co-insurance.

Report to your health plan any attempts by the out-of-network health care provider to bill you for these types of services above what you would pay for in-network care. You may also file a complaint with the New Jersey Department of Banking and Insurance online. Or call the consumer hotline at Consumer Hotline 1-800-446-7467, from 8:30 am to 5:00 pm EST Monday through Friday.

To learn more about consumer protections from out-of-network billing, go to: https://www.state.nj.us/dobi/division_consumers/insurance/outofnetwork.html

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 have concerns regarding your Get Covered New Jersey eligibility for financial help or enrollment or believe an error may have been made, please contact the Customer Assistance Center at 1-833-677-1010.

If you believe a decision your health plan carrier made is wrong and is negatively affecting your access to medical 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 you do not have a health insurance card, contact your health plan. They may be able to tell you your member number or send you a temporary card to give your doctor or pharmacy. Here is a list of insurance companies and their customer service phone numbers.

If you get care after your coverage starts but before you get your card, you may have to pay for your care at the time of service. If you pay for covered services, you can file a claim with your health plan to get it paid back.

You pay your premium directly to your health plan. Follow their instructions for how and when to pay your premium. You may be able to pay online. Look for the “Pay Now” button in your account after you choose your plan. It is important to pay your total monthly premium to your health plan by the due date to start your coverage. Your coverage could end if you do not pay your monthly premiums. If you do not get the bill from the insurance company as your due date comes close, you can make the payment via phone with your insurer. Here is a list of insurance companies and their customer service phone numbers.

You can learn more about submitting documentation to resolve a Data Matching Issue at After You Apply

Alternative Attestations for Income Data Matching Issue

Applicants may need to provide documentation for income, referred to as an Income Data Matching Issue (DMI). If you have an income DMI, you should review the list of acceptable documents in the notices received and provide those documents to verify your income. In the rare event you are unable to provide any of the other existing acceptable income documents, you may sign and submit an Attestation of Frequently Changing Monthly Income or Attestation of Other Income. There are legal and financial implications for knowingly providing inaccurate income information on the Get Covered New Jersey application. If you think this document may be what you need, you are encouraged to find free help from a certified assister, agent, or broker or call the Customer Call Center.

Attestation of Frequently Changing Monthly Income

Attestation of Other Income

A Non-Employer Sponsored Insurance (ESI) Minimum Essential Coverage (MEC) data matching issue occurs when the Marketplace cannot verify your enrollment status in a government-sponsored health program. These health programs include: Medicare Parts A and B, NJ FamilyCare, Medicaid, Children’s Health Insurance Program (CHIP), Tricare, Refugee Medical Assistance, VA health care program, the Civilian Health and Medical program, or the Department of Defense Non-appropriated Fund Health Benefits Program.

If you are enrolled in any of the above coverage programs and expect to stay enrolled, then you will not be eligible for health insurance through Get Covered New Jersey.

To show proof that you are not enrolled in coverage through NJ FamilyCare (Medicaid or CHIP), submit one of the following documents:

  • Letter or statement from NJ FamilyCare that shows that you or your family members were denied Medicaid or CHIP (NJ FamilyCare) coverage or that your NJ FamilyCare coverage has recently ended. 
  • Letter, document, or statement from NJ FamilyCare showing that you or a family member are enrolled in a Medicaid program that is not considered minimum essential coverage, including coverage only for family planning services (“NJ FamilyCare Plan First Program”) or emergency treatment.

To show proof that you are not enrolled in Medicare, provide one of the following-

  • Letter or statement from Medicare or the Social Security Administration stating that you or your family members are no longer enrolled in Medicare or no longer eligible for Social Security Disability Insurance (SSDI) benefits, and your coverage has ended.

If you have recently been disenrolled from any of the above programs or are losing that coverage soon, you need to submit documentation to demonstrate the loss of coverage. Acceptable documentation includes:

  • Letter from Veterans Affairs and/or Veterans Administration
  • Letter from insurance company about health coverage, including coverage end date
  • Letter from Peace Corps
  • In the rare event you are unable to provide any of the other existing acceptable documents, you may sign and submit an Attestation Regarding Other Minimum Essential Coverage. There are legal and financial implications for knowingly providing inaccurate coverage information on the Get Covered New Jersey application. If you think this document may be what you need, you are encouraged to find free help from a certified assister, agent, or broker or call the Customer Call Center.

Attestation Regarding Other Minimum Essential Coverage

If a member of your household has been identified as deceased as part of the automatic check that Get Covered New Jersey does periodically with the Social Security Administration, Get Covered New Jersey is required by the federal government to terminate coverage for the deceased member. If this information is accurate, you should update your account by contacting Get Covered New Jersey to report the passing of the household member. If you or a family member have been incorrectly identified as deceased,  please complete the following steps within 30 days of this notice:  

  • Call the consumer assistance center at 1-833-677-1010 about this notice; or
  • Upload a letter or statement attesting that you or a family member have been incorrectly identified as deceased, and you will contact the Social Security Administration to correct this information.
  • Note: Any consumer incorrectly identified as deceased should promptly contact the Social Security Administration to report that the household member was identified as deceased by mistake. Visit socialsecurity.gov, go to your local Social Security office, or call Social Security at 1-800-772-1213.

Form 1095-A, also called the Health Insurance Marketplace Statement, is an IRS form related to your health insurance coverage. You will receive this statement from Get Covered New Jersey if you or a household member received help paying for health insurance that you purchased through Get Covered New Jersey.  Form 1095-A is needed to file your Federal Income Tax Return.  It shows how many months you had health insurance coverage and the amount of Advanced Premium Tax Credit (APTC) you received.  You will use form 1095-A to complete Form 8962, Premium Tax Credit, to report the amount of APTC you received in 2021 on your 2021 tax filing in early 2022. 

The Form 8962 will calculate if you can receive more of a tax credit or if you owe any amount back. The Advanced Premium Tax Credit is based on the amount of income on your 2021 Get Covered New Jersey application. Form 8962 will look at your final 2021 income, as reported on your taxes. If your income or household size changed during 2021, you may owe back part of the premium tax credit or you may get more premium tax credit.

The 1095-A form does not include any state subsidy you received – called New Jersey Health Plan Savings (NJHPS) - and only includes the federal financial help received, called Advanced Premium Tax Credits/APTCs. The New Jersey Health Plan Savings financial help does not get reported through the 1095-A and Form 8962 and consumers should only report the APTC amounts on the 1095-A form. If you include New Jersey Health Plan Savings on your Form 8962, it could result in the IRS incorrectly calculating your final APTC for the year and may result in you paying back APTC. For more information on form 1095-A, please visit Health Insurance Marketplace Statements.

Get Covered New Jersey will mail you the Form 1095-A by January 31st after the coverage year.  You may receive more than one 1095-A form if you changed plans or had other changes during 2021.

If you elected to receive your Form 1095-A by paper mail, you will receive it by the beginning of February. Look for an envelope that says “Important Tax Information Enclosed” and the Get Covered New Jersey logo. You can also find your Form 1095-A in your secure account at GetCovered.NJ.gov.

If you elected to receive your Form 1095-A electronically, you can download the form from your secure mailbox in your Get Covered New Jersey account by January 31st.  After logging in to your Get Covered New Jersey account, select “My Inbox” and click on the notification titled “1095A Form for Health Plan”.

If you wish to change the settings for how you receive your 1095-A form, you can update your account at Get Covered New Jersey. The communication preferences for the 1095-A form is a separate question from the general communication preferences.

If you do not receive your Form 1095-A form shortly after January 31st, 2022 and you were enrolled in a health insurance plan through Get Covered New Jersey in 2021, please call Get Covered New Jersey at 1-833-677-1010.

For the first time in 2021, the State of New Jersey provided additional financial help to lower health insurance premiums. This state subsidy, referred to as the New Jersey Health Plan Savings, is not connected to your federal or state taxes.  Do not include the New Jersey Health Plan Savings (NJHPS) on your federal tax return.  The state financial help does not need to be reported with the federal Advance Premium Tax Credit (APTC) amounts.  The numbers listed in Part III, Column C of the 1095-A form reflect only the 2021 federal financial help you received.  Column C may be a different than the total financial help you received in 2021 because it does not include the state subsidy.

If you believe that the federal financial help listed is different than the APTC you received throughout the year, make sure you are reviewing all of your 1095-A forms (if you receive more than one). If you have questions, call Get Covered New Jersey at 1-833-677-1010.

Due to the COVID-19 Pandemic, the federal government passed a bill in March of 2021 called the American Rescue Plan Act that provided additional financial help to eligible consumers purchasing insurance through marketplaces, including Get Covered New Jersey. The new savings became available at Get Covered New Jersey on April 15th, with lower premiums taking effect as early as May 1, 2021. During the month of June, Get Covered New Jersey automatically updated financial help for as many consumers as possible to reduce premiums for eligible customers who had not yet taken action.

It is important to note that although the new financial help was applied to lower your premiums prospectively beginning in June for most consumers, that additional financial help was applicable to any months prior to June during 2021 that a consumer was enrolled in a plan and eligible for financial help. This means that consumers who were enrolled in coverage through Get Covered New Jersey earlier in the year may be eligible for additional Premium Tax Credits at tax time. Filing IRS Form 8962 form to report and reconcile Advance Premium Tax Credits will allow IRS to determine if additional tax credits will be paid for earlier months.

You will receive one Form 1095-A for each Health Insurance Marketplace plan that you or members of your household enrolled in through Get Covered New Jersey during 2021. Additionally, you will also receive more than one Form 1095-A for the following reasons:

  • If you or members of your household were not all enrolled in the same health plan
  • If you updated your household information during the year
  • If you switched plans during the year
  • If you received a corrected Form 1095-A due to errors on your original Form 1095-A

Note: If you or members of your household were enrolled in coverage in different states during the coverage year, you will receive a Form 1095-A from each state’s Health Insurance Marketplace where you were enrolled in coverage.

Yes. Consumers that received unemployment compensation during 2021 qualified for additional Advanced Premium Tax Credit (APTC) through the federal government that allowed them to have near zero monthly premiums regardless of their income level. When completing your IRS Form 8962 to report and reconcile your Premium Tax Credits, you will need to check the box at the top of the form for question A indicating whether you or your spouse received unemployment compensation in 2021. If you do not check this box, the federal government may not be aware that you were eligible for additional APTC due to receiving unemployment compensation and you may incorrectly owe money at tax time.  If you have questions or concerns, please contact your tax professional for additional assistance. 

To report a suspected error on your Form 1095-A, please call Get Covered New Jersey right away at 1-833-677-1010.  Get Covered New Jersey will review your coverage records and send you a corrected Form 1095-A if needed. Call if you think your Form 1095-A has:

  • Months of coverage for you or any members of your household that are different than what you expected
  • Household members are missing from the form
  • Incorrect demographics on the form: address, social security number, or date of birth
  • Monthly enrollment premiums and/or the monthly advance payment of premium tax credit amounts that are different than what you thought you received for one or more months

If you received a Form 1095-A with the "CORRECTED" box checked at the top, it generally means that you previously received a Form 1095-A containing one or more errors. Visit Corrected, Incorrect or Voided Forms 1095-A for information.

To avoid having to repay advance premium tax credits, you should do the following:

  • Make sure Get Covered New Jersey has your most up-to-date income information
  • Report any changes to your household size, income, and other health insurance coverage to Get Covered New Jersey as quickly as possible.
  • Consider taking less than the full amount of advance premium tax credit available to you. You may select any amount of the premium tax credit you are eligible to receive in advance, and then receive the remainder of the premium tax credit on your taxes if you end up being eligible for a larger tax credit than you used throughout the coverage year. This option is available on GetCovered.NJ.gov as a last step before you finalize your enrollment (look for the “Adjust APTC” button).

If you or a member of your household were enrolled in Medicaid, Children’s Health Insurance Program (CHIP), or NJ FamilyCare at some point in the coverage year, you should receive Form 1095-B from the State of New Jersey. If you were enrolled in other types of coverage - such as a catastrophic plan, Medicare Parts A or C, TRICARE, benefits from the Department of Veteran Affairs, or certain employer-sponsored health insurance – you may receive Form 1095-B or Form 1095-C from other sources. 

Get Covered New Jersey only provides Form 1095-A and does not provide Form 1095-B “Health Coverage” or Form 1095-C “Employer-Provided Health Insurance Offer and Coverage”.

Form 1095-B Tax is sent to individuals to report other minimum essential coverage that includes government-sponsored programs such as Medicaid/CHIP/Medicare, individual market plans, and other coverage the U.S. Department of Health and Human Services designates as minimum essential coverage.

Form 1095-C is furnished to any employee of an Applicable Large Employers (ALE) who is a full-time employee for one or more months of the calendar.

No. You will not receive a Form 1095-A for a catastrophic plan purchased through Get Covered New Jersey because these plans are not eligible for the premium tax credit.

Get Covered New Jersey offered the catastrophic plans listed below in 2021. You will not receive a Form 1095-A if you purchased one of these plans.

  • Horizon Advantage EPO Essentials by Horizon Blue Cross Blue Shield of New Jersey
  • IHC Local Value Simple Saver by AmeriHealth New Jersey
  • Oscar Secure by Oscar Garden State Insurance Corporation

You will receive a Form 1095-B (titled “Health Coverage”) for catastrophic coverage directly from the health insurance company (see prior question for more information on the 1095-B).

While Get Covered New Jersey can help you with certain issues related to Form 1095-A, you may have additional questions, particularly about how the form affects your taxes. Additional resources to help you can be found at the following pages:

Get Covered New Jersey does not provide tax advice. You can share this information with your tax preparer if you have one. Many people can get free help to fill out their taxes. Visit IRS.gov/Individuals/Free-Tax-Return-Preparation-for-You-by-Volunteers to learn more.

You can have a GetCoveredNJ health insurance plan with or without financial help until you become eligible for Medicare. Once you are eligible to enroll in Medicare because you are turning 65, you should complete the requirements to sign up for Medicare coverage within three months of your 65th birthday. Once eligible for Medicare, you are no longer eligible for financial help with the cost of your GetCoveredNJ coverage and your GetCoveredNJ health insurance plan will only pay minimal costs as a secondary payer.

If you are under age 65 and receive Medicare because of a disability and you did not sign up for Medicare Part B coverage, you CANNOT use a GetCoveredNJ health insurance plan to cover your Part B costs.

If you have a GetCoveredNJ plan at the time when you become eligible to enroll in Medicare, you may cancel the GetCoveredNJ plan a month prior to start your Medicare or choose to keep your GetCoveredNJ plan for the rest of the plan year without any financial help (at full cost).

A GetCoveredNJ plan is not a substitute for Medicare and it is not a Medicare Supplement Plan. People covered under a GetCoveredNJ plan who become eligible for Medicare should consider all of their options.

See Medicare.gov for more information. If you need help with Medicare eligibility or coverage questions, contact:

✓ New Jersey’s Division of Aging and Community Services, State Health Insurance Assistance Program at 1-800-792-8820

Medicare.gov or 1-800-MEDICARE

✓ Your County’s Office on Aging (contact information at https://www.state.nj.us/humanservices/doas/home/saaaa.html)

 

Many individuals over 65 will be eligible for full coverage under Medicare and should not enroll in GetCoveredNJ coverage. However, some individuals pay a premium for Medicare Part A or are not eligible for Medicare. Individuals in this situation may be eligible for coverage through GetCoveredNJ, but should consult a Medicare expert before applying for GetCoveredNJ. Local and national Medicare resources include:

✓ New Jersey’s Division of Aging and Community Services, State Health Insurance Assistance Program at 1-800-792-8820

Medicare.gov or 1-800-MEDICARE

✓ Your County’s Office on Aging (contact information at https://www.state.nj.us/humanservices/doas/home/saaaa.html)

In New Jersey, NJ FamilyCare is the Medicaid and Children’s Health Insurance Program (CHIP). If your eligibility notice said you would hear from NJ FamilyCare, your application was transferred to NJ FamilyCare (Medicaid/CHIP) for pending Medicaid/CHIP eligibility because, based on the information you provided in your application, you are likely eligible for NJ FamilyCare. You should respond to any mail and requests for information from NJ FamilyCare. You may contact NJ FamilyCare for more information at 1-800-701-0710.

If you qualify for Medicaid (NJ Familycare) coverage, you are not eligible to receive GetCoveredNJ financial help. Your income and household size are what makes you eligible for Medicaid, CHIP, or GetCoveredNJ financial help. You are not able to choose between programs. If you are willing to pay a full premium for a health plan, you can buy a plan through Get Covered New Jersey. Generally, disenrolling from Medicaid will not make you eligible for GetCoveredNJ financial help. You may apply for GetCoveredNJ coverage if you become ineligible for Medicaid or CHIP.

If your employer offers health insurance that meets minimum essential coverage, you are not eligible for GetCoveredNJ financial help. If your insurance premium contribution is not affordable (higher than 9.61% of your annual income), you can buy health insurance from GetCoveredNJ with financial help.

Yes. However, you will not qualify for the premium tax credit and other marketplace financial help 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 your employer does not offer health insurance for your family, your family can buy health insurance through GetCoveredNJ with financial help. As a reminder, all tax household members should be included on the GetCoveredNJ application, even if they are not seeking coverage.

Yes, the new financial help provided by the American Rescue Plan Act and the State of New Jersey became available on April 15th, 2021 with lower premiums taking effect as early as May 1, 2021. If you had 2021 coverage through GetCoveredNJ, and made an update on your application after May 1, 2021, you should have received updated financial help. Get Covered New Jersey also automatically updated financial help for many existing consumers in June 2021. This increased expanded financial help is continued in 2022.

Yes. Health insurance companies are required to waive cost-sharing, including lab fees, co-payments, coinsurance, and deductibles for any visit to test for coronavirus at a doctor’s office, urgent care center, or emergency room, and for a coronavirus vaccine. Additionally, if the primary purpose of an office visit is the delivery of the COVID-19 immunization, then insurance companies may not impose cost-sharing requirements for the office visit.

For more information on the coronavirus, including testing and vaccine locations, visit the New Jersey COVID-19 Information Hub at https://covid19.nj.gov/ For vaccine information, you may also call the state’s COVID-19 Vaccine Call Center at 855-568-0545.

New Jersey Department of Health: https://www.nj.gov/health/

Centers for Disease Control and Prevention: https://www.cdc.gov/

Individuals who have received unemployment insurance were eligible for nearly free premiums regardless of their income in 2021. Unfortunately, this federal benefit is no longer available in 2022. However, 9 in 10 people enrolling at Get Covered New Jersey qualify for financial help. See if you qualify to receive financial help based on your current income and household size.

The new financial help is only available for consumers enrolled through GetCoveredNJ. You could be newly eligible for increased financial savings if you switch your health insurance coverage to a plan on GetCoveredNJ. You can use the Shop and Compare tool to get an estimate of your potential savings before submitting a full application.

If you are enrolled with a company that offers plans on GetCoveredNJ, you may be able to switch to the same plan through the marketplace. You can talk to your health insurance company about carrying over the money spent on your deductible to your GetCoveredNJ plan. If you have questions, you can Find Local Assistance to guide you through the process.

Thank you for your interest! Get Covered New Jersey materials are available for distribution in English and Spanish, and may be printed from our Resources page.

Information for brokers and assisters may be found on our website here.


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