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New Jersey Health Insurance Guide
New Jersey Health Insurance Information, Resources and Access to Online Health Insurance Quotes
As a New Jersey resident you can choose from health insurance plans offered to individuals and groups by private insurance companies. You may also purchase individual and family coverage from participating private insurers through HealthCare.gov, the federal exchange. If you are self-employed with no employees, you can also use the federal exchange to purchase coverage. You may also be entitled to certain state and federal programs such as Medicaid and COBRA.
In addition, if you are under 30 or meet the criteria for a hardship exemption, you can purchase a catastrophic plan that is compliant with ACA requirements.
Premiums charged for any of the qualifying metal plans may be based on:
- Your age
- Tobacco use
- Where you live - determined by rating area
- The number of family members enrolling with you
Guaranteed Issue
Under ACA, no one can be denied coverage or charged significantly higher premiums because of past health history (pre-existing conditions) or gender. There can be no look-back or waiting periods imposed. Policies are effective on issue. All coverage is renewable, if you choose to renew it. Plans can only be canceled for non-payment of premiums or fraud. The guaranteed issue provision applies to all non-grandfathered plans.
ACA Financial Assistance
You may qualify for financial assistance in the form of tax credits to help with monthly premiums and subsidies to help with out-of-pocket costs.
- Tax credits can be applied to any of the four metal plans to lower your monthly premiums. They are paid directly to your insurance provider by the federal government. Your tax credit is based on your estimated income for the calendar year, in advance of filing your federal return. Note that if your actual income exceeds the eligibility limit, you will have to reimburse the government for the difference. Tax credits are only available to New Jersey residents who purchase coverage from HealthCare.gov.
- Subsidies to help New Jersey residents with out-of-pocket expenses such as copayments are only available for Silver plans purchased through HealthCare.gov and are only offered to those who earn up to 250% of the federal poverty level.
Provider Options
The following types of health insurance plans are available in New Jersey for individuals and families. They may be purchased through private providers or providers participating in New Jersey through the federal exchange, HealthCare.gov.
- Preferred Provider Organizations (PPOs)
You have access to a network of healthcare providers participating in your selected PPO. You do not have to select a Primary Care Physician or obtain a referral to see any in-network provider. Some PPOs may require that you meet a deductible before their portion of the coverage begins.
Health Maintenance Organizations (HMOs)
Most HMOs require you to select a Primary Care Physician to coordinate your healthcare and provide referrals to specialists. HMOs typically charge a fixed copayment for each doctor visit and other care provided. Depending on the HMO, there may be a low deductible or no deductible in addition to the copayments. All services must be obtained through the HMO’s network, unless otherwise stated in your plan.
High-Deductible Health Plans with Health Savings Accounts (HDHP w/HSAs)
These plans give you more control over your out-of-pocket expenses by offering lower monthly premiums with higher deductibles. They are typically combined with HSAs that allow you to set aside interest-earning pretax funds (through your employer’s payroll deduction) or tax-deductible funds you deposit in a private account. These funds can be drawn on to cover your healthcare costs. Any interest accrued is tax-deferred and any unused funds can roll over from year to year. See your tax advisor for information specific to your situation.
Flexible Spending Accounts (FSAs)
ACA provisions allow you to continue to make tax-free contributions up to $2,500 per year to an FSA. These can be used for out-of-pocket healthcare expenses not covered by your insurance plan. This includes many over-the-counter (OTC) preparations, devices and equipment as allowed by law. However, you will need to obtain a prescription for OTC items and submit an itemized receipt to qualify for the tax deduction.
- New Jersey Family Care - Health insurance for families without health insurance who have children under age 19 - http://www.njfamilycare.org/default.aspx
- AIDS Drug Distribution Program - http://www.state.nj.us/health/aids/freemeds.shtml
- Catastrophic Illness in Children Relief Fund – reimbursement for expenses associated with a child’s acut or chronic illness or condition - http://www.state.nj.us/humanservices/cicrf/home/
- Charity Care Hospital Care Payment Assistance - http://www.state.nj.us/health/charitycare/index.shtml
- Diabetic Eye Disease Detection Program – screening and referrals - http://www.state.nj.us/health/fhs/diabetes/comm.shtml
- End Stage Renal Disease Assistance Program - http://www.state.nj.us/health/fhs/chronic/renal.shtml
- Early Intervention System – assistance for children through age two with developmental delays - http://www.state.nj.us/health/fhs/eis/index.shtml
- Respite Care Program – financial assistance for respite care for families with members who have disabilities - http://www.state.nj.us/humanservices/doas/services/srcp/
- Special Child Health Services – care for children through age 21 with special health care needs - http://nj.gov/health/fhs/sch/index.shtml
- Traumatic Brain Injury Fund – support and services for survivors of acquired brain injuries - http://www.state.nj.us/humanservices/dds/oias/tbis/tbifund.html
- Clinic List – free and low-cost clinics - http://www.needymeds.org/free_clinics.taf?_function=list width:670px;height:90px"
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