Market Preservation Act Information
The New Jersey Health Insurance Market Preservation Act requires every New Jersey resident to obtain health insurance, have a valid exemption, or make a Shared Responsibility Payment (SRP).
By encouraging more residents to get coverage, this law stabilizes New Jersey’s insurance market and reduces premiums, thus supporting the federal Affordable Care Act.
The law requires you and your family to have Minimum Essential Coverage (MEC) throughout the year, qualify for an exemption, or remit an SRP when you file your New Jersey Income Tax return.
New Jersey grants exemptions if you have a short gap in coverage, when premiums are unaffordable, or for other reasons listed on the Exemptions Page. Individuals who are not required to file a New Jersey Income Tax return are automatically exempt from the SRP and don’t have to file for an exemption.
Most basic health coverage satisfies State requirements, including insurance plans through an employer, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and NJ FamilyCare. Plans that provide only limited benefits – such as vision or dental plans – do not. If you are not sure if your coverage qualifies as Minimum Essential Coverage, ask your health plan provider.
To enroll in health coverage for 2021, you must apply during the open enrollment period. Open enrollment for 2021 policies begins on Nov. 1, 2020, and ends on January 31, 2021. You can enroll after the open enrollment period only if you have an income or life changing event.
When you have coverage, you can indicate on your New Jersey Resident Return (Form NJ-1040) that you and your dependents have health care, and you will not be assessed a Shared Responsibility Payment.
The following types of health coverage satisfy the coverage requirement:
- Any 2020 health plan bought through Healthcare.gov site or, for 2021 and beyond, any plan purchased through the GetCovered website.
Individual health plans bought outside the Health Insurance Marketplace, if they meet New Jersey’s standards for qualified health coverage. Plans must qualify as Minimum Essential Coverage, as required under the Affordable Care Act, as it was in effect on December 15, 2017. (See below for what constitutes Minimum Essential Coverage.)
- Any “grandfathered” individual insurance plan you’ve had since March 23, 2010, or earlier
- Most job-based plans including retiree plans and COBRA coverage
- Medicare Part A (You don’t have Minimum Essential Coverage if you have only Medicare Part B.)
- Coverage under a parent’s plan (Once you have turned 26 years old, you may remain on your parent’s plan until January 1 of the next calendar year.)
- Most student health plans (Check with your school to see if the plan counts as qualifying health coverage)
- Health coverage for Peace Corps volunteers
- Certain types of veterans health coverage through the Department of Veterans Affairs
- Most TRICARE plans
- Department of Defense Non-Appropriated Fund Health Benefits Program
- Refuge Medical Assistance
Some products that help pay for medical services don't qualify.
- Coverage only for vision care or dental care
- Workers' compensation
- Coverage only for a specific disease or condition
- Plans that offer only discounts on medical services
Minimum essential coverage means health care coverage under any of the following programs. It doesn’t, however, include coverage consisting solely of excepted benefits. Excepted benefits include stand-alone vision and dental plans, workers' compensation coverage, and coverage limited to a specified disease or illness. Employer-sponsored coverage:
Individual market coverage:
- Group health insurance coverage for employees under:
- A plan or coverage offered in the small or large group market in New Jersey.
- A plan provided by a governmental employer, such as the Federal Employees Health Benefits program
- A grandfathered health plan offered in a group market.
- A self-insured health plan for employees
- COBRA coverage
- Retiree coverage
- Coverage under an expatriate health plan for employees and related individuals
- Department of Defense Non-Appropriated Fund Health Benefits Program.
Coverage under government-sponsored programs:
- Health insurance you purchase directly from an insurance company
- Health insurance you purchase through the Marketplace
- Health insurance provided through a student health plan
- Catastrophic coverage
- Coverage under an expatriate health plan for non-employees such as students and missionaries
- Medicare Part A coverage
- Medicare Advantage plans
- Most Medicaid coverage
- Children's Health Insurance Program (CHIP) coverage
- Most types of TRICARE coverage
- Comprehensive health care programs offered by the Department of Veterans Affairs
- Health coverage provided to Peace Corps volunteers
- Refugee Medical Assistance
- Coverage through a Basic Health Program (BHP) standard health plan.
- Coverage under a group health plan provided through insurance regulated by a foreign government if (1) a covered individual is physically absent from the United States for at least 1 day during the month, or (2) a covered individual is physically present in the United States for a full month and coverage provides health benefits within the United States while the individual is on expatriate status
- Certain coverage provided to business owners who aren’t employees
- Coverage recognized by the U.S. Department of Health and Human Services as
minimum essential coverage.