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New Jersey Health Insurance

Published: April 2nd, 2020

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All New Jersey residents must have health insurance (in most cases). Luckily, you can choose from several private and public health plans.

The Garden State is more than just the Jersey Shore. It’s home to one of the longest-running programs that give residents access to comprehensive, private health coverage. New Jersey is also one of the first states to have a mandate requiring residents to have health insurance. Some people can claim an exemption for reasons such as hardship.

Below, we summarize some of the key points about New Jersey’s health insurance options. 

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New Jersey Individual Health Coverage Program 

Long before the Affordable Care Act (or Obamacare) became law in 2010, New Jersey enacted its own healthcare legislation that gave ACA-like protections to residents. The Garden State established the Individual Health Coverage (IHC) Program in 1992. The program gave residents without government-sponsored or employer coverage access to private health insurance.

Like the ACA, New Jersey’s IHC members can buy individual and family plans from private insurers regardless of age or health status.

New Jersey’s IHC plans are available through the federal Marketplace at Healthcare.gov as well as off of it. You can get an IHC plan during the annual open enrollment from November 1 to December 15 each year. To qualify, you must live in New Jersey, and you cannot be eligible for Medicare.  

New Jersey’s Individual Mandate

The ACA’s individual mandate requiring all Americans to have qualified health coverage was repealed effective 2019. But New Jersey lawmakers created a state-based individual mandate (bill A.3380) to counteract this decision. The bill, officially called the New Jersey Health Insurance Market Preservation Act, was signed into law by Governor Phil Murphy in May 2018. It went into effect in 2019.1

New Jersey Health Insurance Marketplace 

New Jersey operates a state-based exchange with a federal platform (SBE-FP).2 The state provides a website (Get Covered New Jersey) and local Navigators to help residents choose coverage. But actual enrollments take place through the federal government’s Healthcare.gov site.

New Jersey will implement a fully state-based health insurance platform for the 2021 open enrollment season.

About 255,000 residents enrolled in 2020 coverage through New Jersey’s Health Insurance Marketplace.

New Jersey Health Insurance Companies Offering Individual and Families 

Three New Jersey health insurance companies offer 2020 Obamacare plans on the exchange, and one only offers options off the exchange. Residents have access to bronze, silver, gold, and catastrophic health plans from these carriers:3 6  

1. AmeriHealth

2. Horizon Blue Cross Blue Shield of N.J.

3. Oscar Insurance 

4. Oxford Health (off the exchange only)

Access to Low-Cost Health Insurance With Obamacare Subsidies 

About 4 in 5 New Jerseyans qualified for Marketplace subsidies in 2019.4 Obamacare subsidies, or premium tax credits, offer financial assistance to reduce your monthly premium on metal plans.

Many single people and families save hundreds of dollars with subsidies—giving them access to low-cost health insurance in New Jersey.

Single New Jerseyans typically qualify for premium tax credits with a maximum income of around $49,960 per year. A family of four usually qualifies with an annual income at or below $103,000.

Here are some examples of New Jersey health insurance costs after subsidies:

A 21 year old in Newark, N.J., earning 25,000 a year, could get a silver plan for $135 per month with subsidies ($305 without them).

A family of four in Trenton, N.J., earning $50,000 a year, could buy a silver plan for $259 per month with subsidies ($1,076 without them).

How Did the Affordable Care Act (Obamacare) Impact New Jersey?

The 2010 Affordable Care Act (Obamacare) gave millions of Americans access to health insurance, which lowered the nation’s uninsured population. However, New Jersey’s uninsured rate didn’t start to decline until 2014. Coincidentally, New Jersey adopted Medicaid expansion under the Affordable Care Act in the same year.

Thirteen percent of New Jersey’s population was uninsured from 2010 to 2013. This number dropped to 11% in 2014 after 206,100 more residents signed up for health insurance. The uninsured rate fell further to 7% in 2018—the lowest it has ever been since the ACA was implemented. An additional 314,300 residents gained coverage.5

New Jersey’s Medicaid Expansion 

New Jersey expanded Medicaid to include childless adults earning up to 138% of the federal poverty level ($2,829 per month for a family of four). This move led to more residents having health insurance. The state’s Medicaid population went from 1.3 million in 2014 to roughly 1.5 million in 2015.6 As of October 2019, more than 580,000 adults gained coverage because of New Jersey’s Medicaid expansion.

Who Qualifies for New Jersey’s Low-Income Health Insurance Programs 

Low-income residents access public health insurance programs through  NJ FamilyCare. It includes Medicaid and the Children’s Health Insurance Program (CHIP). Both programs offer low-cost or no-cost coverage to eligible residents.

Medicaid in New Jersey is available to U.S. citizens and permanent legal residents, including:

  • Childless adults ages 19-64 who qualify because of the expansion
  • People 65 and older
  • People with disabilities
  • Children under 19 (eligible for regular Medicaid)
  • Children under 21 who don’t qualify for regular Medicaid can get benefits through the Medicaid Special or Medically Needy Program)
  • Parents and caretakers of dependent children
  • Pregnant women (newborns of FamilyCare mothers qualify for coverage up to one year after birth regardless of changes to parent(s) income)

The general income limit for Medicaid in New Jersey is $16,612 for an individual as of 2019. The income limit increases by about $5,878 for each additional person in the household.

CHIP

About 225,000 residents enrolled in New’s Jersey Children’s Health Insurance Program (CHIP) in 2019.7 This number includes children under 19 and low-income pregnant women. Your household may qualify for CHIP if you make up to $59,185 for a family of two in 2019. The income limit increases by $15,470 for each additional person.

Medicare Plans for Seniors and Adults Under 65 With Disabilities 

New Jersey residents age 65 and older make up 87% of the state’s Medicare beneficiaries. Individuals under 65 who qualify due to a disability make up the rest.

Original Medicare versus Medicare Advantage

New Jerseyans can choose between Original Medicare or Medicare Advantage to get Part A hospital and Part B medical insurance. Original Medicare is the traditional way most people receive benefits. Nearly 1.3 million N.J. residents have Original Medicare as of 2018. Meanwhile, about 360,000 residents chose private Medicare Advantage plans.

Medicare Advantage plans offer extra benefits beyond Traditional Medicare. Most include prescription drug coverage, and some offer other benefits, such as routine dental, vision, and hearing care.

Medicare Part D Drug Coverage and Medicare Supplement

Traditional Medicare has coverage gaps, such as limited drug coverage and out-of-pocket expenses. Enrollees who want prescription drug benefits usually add a separate Medicare Part D drug plan from a private insurance company. In 2018, more than 915,000 New Jersey residents had a stand-alone Part D plan.

Original Medicare beneficiaries can also add a Medicare Supplement (called Medigap) plan to help cover some or all of their out-of-pocket costs, including copayments, co-insurance, and deductibles.

Medigap is widely available to people 65 and older. But New Jersey’s Medigap regulations make it easier for younger beneficiaries to access coverage. Insurers must offer Medigap Plan C to Medicare disability enrollees under 50 as well as those 50 to 64. Insurers are barred from charging them higher premiums for Plan C than those aged 65.

Short-Term Health Insurance in New Jersey

Federal rules allow states to offer short-term health insurance for up to 364 days with the option to renew coverage for up to 36 months. However, New Jersey prohibits the sale of short-term health plans because they don’t comply with the state’s Individual Health Coverage (IHC) Program.

New Jersey’s Department of Banking and Insurance believes that selling short-term health plans would lead to younger, healthier individuals choosing “inferior coverage.”

Now that you have more information about buying health insurance in New Jersey, you can decide which type of coverage is right for you. 

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Article Sources
  1. Keith, Katie. “New Jersey Becomes Second State To Adopt Individual Mandate; Ohio Attempt To Waive Mandate Rejected.” Health Affairs, June 1, 2018 (accessed December 25, 2019).

  2. State of New Jersey Department of Banking and Insurance. “New Jersey State-Based Exchange Transition Overview Plan Year 2020 & 2021.”state.nj.us/dobi (accessed December 25, 2019).

  3. State of New Jersey Department of Banking and Insurance. “2020 New Jersey Individual Health Benefits Plans and Rates Effective 01/01/2020 – 12/31/2020.” state.nj.us/dobi (accessed December 25, 2019).

  4. Kaiser Family Foundation. “Marketplace Effectuated Enrollment and Financial Assistance.” KFF.org (accessed December 25, 2019).

  5. Kaiser Family Foundation. “Health Insurance Coverage of the Total Population.” KFF.org (accessed December 25, 2019).

  6. Kaiser Family Foundation. “Health Insurance Coverage of the Total Population.” KFF.org (accessed December 25, 2019).

  7. U.S. Government Website for Medicaid. “September 2019 Medicaid & CHIP Enrollment Data Highlights.” Medicaid.gov (accessed December 25, 2019).