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Aetna has joined New Jersey's exchange for 2023; State-funded subsidies supplement federal subsidies; Easy enrollment program will be in use as of early 2024
New Jersey operates its own exchange platform (GetCoveredNJ). Aetna joined the exchange for 2023, increasing to five the number of insurers offering plans through the exchange.
Enrollment also hit a new record high for 2022 as 311,692 people enrolled in private individual market plans through the New Jersey exchange during open enrollment.
New Jersey’s new state-funded premium subsidies (available as of 2021) have been expanded to apply to more households. The program, called New Jersey Health Plan Savings, is available to GetCoveredNJ enrollees with household income up to 600% of the poverty level.
New Jersey has enacted legislation to create an “easy enrollment” program that will be in use as of early 2024, helping uninsured people get connected with health coverage via their state tax returns.
From 2014 through 2020, New Jersey used the federally run exchange, which means residents enrolled in exchange plans through HealthCare.gov. But New Jersey transitioned away from HealthCare.gov in the fall of 2020, and is now operating its own exchange platform, using the GetCoveredNJ website.
From the fall of 2013 through the 2020 plan year, New Jersey used HealthCare.gov, like the majority of the rest of the states. But in March 2019, Governor Phil Murphy notified CMS that New Jersey planned to begin running its own health insurance exchange by the 2021 plan year (ie, operational by November 2020).
But New Jersey also requested CMS approval to have the NJ Department of Banking and Insurance oversee the exchange starting in the fall of 2019, when people were purchasing coverage for 2020. That request was approved just a few weeks before the start of open enrollment for 2020 health plans, so New Jersey had a state-based exchange using the federal platform (HealthCare.gov) for the 2020 plan year. The state transitioned to a fully state-run exchange in the fall of 2020, utilizing their own enrollment platform (GetCoveredNJ) instead of HealthCare.gov.
State-run exchanges that use the HealthCare.gov enrollment platform were charged a fee equal to 2.5% of premiums in 2020, down from 3% percent in 2019. So New Jersey paid that 2.5% fee in 2020. But even now that the state has its own exchange, they plan to continue to collect the same 3.5% fee that was collected by the federal government in 2019. But instead of sending it to the federal government, New Jersey will use the money — estimated at $50 million per year — to operate a state-run exchange.
By running its own exchange, New Jersey has gained significantly more control. The state has the flexibility to extend open enrollment (enrollment continues through January 31 in New Jersey), target the state’s enrollment and outreach efforts in the most useful fashion, design the enrollment website and customer service center, and have more regulatory control over the plans for sale in the market.
For 2023 coverage, five insurers offer plans through New Jersey’s exchange. This includes Aetna, which is new for 2023, along with the four insurers that already offered plans as of 2022. For 2023 coverage, plans are available in New Jersey’s exchange from the following insurers:
Oxford also offers individual market plans in New Jersey, but only outside the exchange (no financial assistance is available outside the exchange, so anyone buying an Oxford plan is paying full price premiums and is also not eligible for any assistance with out-of-pocket costs).
As is the case in most states, insurer participation in the exchange has varied over the years in New Jersey. In 2014, there were only three insurers offering plans: Horizon Blue Cross Blue Shield, AmeriHealth, and Health Republic of New Jersey (Freelancer’s CO-OP). But for 2015, Oscar and Oxford joined the exchange. There have been several additional changes since then:
Open enrollment is longer in New Jersey than in most other states. It runs from November 1 to January 31 (in most states, it ends on January 15). The flexibility to extend open enrollment is due to the fact that New Jersey now runs its own exchange platform(GetCoveredNJ).
Outside of the open enrollment window, New Jersey residents can enroll or make changes to their coverage if they qualify for a special enrollment period. In most cases, these require a qualifying event, although qualifying events are not necessary for Native Americans.
And New Jersey also allows a special enrollment period due to pregnancy, which is only available in a handful of other states.
For 2023, average premiums in the individual market in New Jersey increased by 8.8%, with the following average rate changes for each insurer:
But those averages only reflect full-price premiums, and most enrollees don’t pay full price. The majority of New Jersey exchange enrollees receive premium subsidies that offset a significant portion of their monthly cost. For those enrollees, net (after-subsidy) rate changes from one year to another depend on how much the subsidy changes as well as how much their own plan’s rate changes. Subsidy amounts change when the cost of the benchmark plan changes. This can happen because existing plans change their prices or because new insurers move into an area and take over the benchmark spot.
New Jersey’s state-funded premium subsidies continue to be available for 2023, for households earning up to 600% of the poverty level. And the federal premium subsidies, which have been enhanced by the American Rescue Plan, are also available. The state noted that with both programs in place, about 9 out of 10 people enrolling in 2023 coverage through GetCoveredNJ would be available for financial assistance through GetCoveredNJ, and most people would be able to find a plan for under $10/month (that plan may or may not be the best choice, depending on the person’s specific needs).
Average rate changes also don’t account for the fact that premiums increase with age. Even if your insurer’s average premiums don’t change at all from one year to the next, you’ll still pay a higher rate due to the fact that you’re another year older. For people who get premium subsidies, the subsidies grow to keep pace with the age-related premium increases.
Oxford (UnitedHealthcare) offers off-exchange-only plans in New Jersey. Their average rates increased by 8.2% for 2023. Subsidies are not available to offset the cost of off-exchange coverage.
For perspective, here’s a summary of how average individual/family health insurance rates have changed over time in New Jersey:
In July 2020, New Jersey enacted A.4389 (Senate version was S.2676) in an effort to decrease the state’s uninsured rate, close the racial health care disparity gap, and make individual health insurance more affordable.
The legislation, which was signed into law by Governor Murphy on July 31, is expected to generate $224 million in annual funding by replacing the ACA’s health insurance tax (which was eliminated after the end of 2020), with a new state-based assessment on individual and fully-insured large group health plans in New Jersey, starting in 2021.
About a third of the money generated by the assessment is being used to provide ongoing funding for the state’s existing reinsurance program. The other two-thirds is being used to make health insurance more affordable for people with low and modest incomes. Maura Collinsgru, Health Care Program Director for New Jersey Citizen Action, explained that the money would be used to provide state-funded premium subsidies to go along with the federal subsidies provided by the ACA.
Initially, the state-funded subsidies were available to households earning up to 400% of the poverty level, which was the same as the eligibility limit for federal subsidies. But the American Rescue Plan eliminated the income cap for federal subsidy eligibility for 2021 and 2022, and the Inflation Reduction Act extended that through 2025 (ie, there is no longer a “subsidy cliff” for those two years). So New Jersey subsequently announced that as of May 2021, the state-funded subsidies would be available to households with income up to 600% of the poverty level. That continues to be the case for 2023.
New Jersey’s state-funded subsidies are designed to address the fact that even with federal subsidies, health insurance — particularly robust coverage with lower out-of-pocket costs — can often still be unaffordable, even with the subsidies. The American Rescue Plan has made coverage more affordable at almost all income levels, and New Jersey is also expanding the reach of the state-funded subsidies in an effort to continue to make coverage as affordable as possible.
According to a statement from Governor Murphy’s office, the subsidy amount was expected to be at least $564 per enrollee in 2021. During the first five weeks of open enrollment, it had averaged $556 in total annual savings, on top of the federal premium subsidies for which people were eligible; the specifics changed later in 2021 when the state opted to provide subsidies at higher income levels.
As Andrew Sprung explains, New Jersey’s state-funded subsidy amounts are income-based. But unlike the federal subsidies, which are larger for people with lower incomes, New Jersey’s state-funded subsidy is larger for people with higher incomes.
The legislation initially called for the new assessment to be set at 2.75% of premiums, but that was later amended to 2.5% (this is less than insurers were paying under the ACA’s health insurance tax, according to an analysis conducted by New Mexico when a similar bill was being considered there earlier this year).
The assessment only applies to individual market plans and fully insured large group plans (ie, not self-insured large group plans). Collinsgru clarified that the bill originally included small group plans, dental plans, and multiple employer welfare plans among the entities that would be subject to the assessment.
But the amended version of the bill eliminated those entities and focused the assessment only on individual plans and fully insured large group plans. Medicaid managed care plans were not included in either version of the bill, due in part to uncertainty surrounding the Medicaid program under the Trump administration.
324,266 people enrolled in coverage through New Jersey’s exchange during the open enrollment period for 2022 coverage. This was a record high, as was the case in most states.
Across all states that use HealthCare.gov, enrollment previously peaked in 2016 and then declined for several years, but rebounded to a record high for 2022. The declines were caused by a variety of factors, including uncertainty about the GOP efforts to repeal the ACA, and the Trump administration’s decision to sharply reduce funding for Navigators and exchange marketing, and increasing premiums (particularly for people who don’t get premium subsidies).
But some factors that caused enrollment to drop in other states were not a factor (or not as much of a factor) in New Jersey. That includes the elimination of the ACA’s individual mandate penalty (New Jersey implemented its own mandate and penalty as of 2019, but didn’t start heavily marketing it until late in 2019) and the expansion of short-term plans (long-standing New Jersey laws prohibit the sale of short-term plans).
For perspective, here’s a look at enrollment in prior years in New Jersey’s exchange:
In December 2020, S.3238 was introduced in New Jersey’s Senate, calling for the state to create an “easy enrollment” program, similar to the program that Maryland began using in 2020, and that Colorado and Pennsylvania are using as of 2022.
The idea is to allow New Jersey to use state tax returns to identify uninsured residents and then determine, based on data from the tax returns, whether those individuals are eligible for Medicaid or premiums assistance through the New Jersey exchange.
The legislation passed unanimously in both chambers, and was sent to Governor Phil Murphy in June 2021. But in November 2021, Murphy conditionally vetoed it, sending it back to the legislature with his recommendations.
Murphy noted that although he “fully support[s] the concept of integrating unemployment and tax data to streamline enrollment in health coverage, the program designed under the bill presents numerous operational challenges that risk creating consumer confusion and unattainable expectations.” His recommendations include “a longer implementation timeline, a clearer delineation of the work to be performed by each department, and the leveraging of existing systems and programs to increase efficiencies and ensure full compliance with federal law.”
New legislation was introduced in 2022 (A.674 and S.1646) and A.674 was enacted in June 2022.
The previous legislation called for the state to implement the program starting with the 2021 tax year (ie, utilizing tax returns that people file in early 2022). But Gov. Murphy’s recommendations include a longer timeframe to implement the program, and the new legislation calls for it to be applicable for tax years 2023 and beyond. So implementation will begin in early 2024, when people are filing their 2023 tax returns.
A tax filer will be able to check a box on their state tax return indicating that they’d like the state to pass their pertinent information to the exchange (Get Covered NJ) so that their eligibility for health insurance financial assistance can be determined. Medicaid enrollment is available year-round, but the legislation notes that people who are not eligible for Medicaid will be granted a special enrollment period of at least 30 days, during which they can enroll in a private plan through the exchange. Most people will be eligible for premium subsidies, and that information will be communicated to the tax filer by the exchange.
New Jersey regulators announced in July 2018 that the average proposed 2019 rate increase for individual market plans was 5.8%. At that point, the proposed rate increase would have been more than twice that much (12.6%) if the state hadn’t enacted legislation to create its own individual mandate starting in 2019.
The loss of the federal individual mandate penalty drove premiums up all across the country for 2019, but New Jersey insulated itself from that by implementing its own mandate (when there’s no mandate, healthy people are less likely to maintain coverage, which results in a less healthy risk pool and higher premiums for everyone who remains insured).
In addition, New Jersey had submitted a 1332 waiver proposal, seeking federal pass-through funding for a reinsurance program. CMS was still reviewing that proposal when rates were being filed, so the 5.8% average proposed rate increase for New Jersey plans did not account for the reinsurance program. Federal approval for the state’s 1332 waiver came in August 2018. State regulators had already noted that the rates would be revised if and when the reinsurance program was approved, and they expected the 2019 rates to be 15% lower with reinsurance than they would otherwise have been.
Sure enough, Governor Murphy’s office announced in early September that average rates in the individual market would decline by 9.3% in 2019, after accounting for the impact of the reinsurance program. So if New Jersey hadn’t done anything at all, rates would have increased by an average of nearly 13%. But instead, because the state implemented an individual mandate and a reinsurance program, the average rates decreased by more than 9%.
Lawmakers in New Jersey considered a variety of health care reform bills in the 2018 session. Two vitally important bills – to create an individual mandate and a reinsurance program — passed and were signed into law by Governor Murphy in 2018.
New Jersey joined Massachusetts in having an individual mandate in 2019 (as did DC), and was one of several states that implemented a reinsurance program in 2019.
(Reinsurance has proven quite popular; 17 states have reinsurance programs in place as of 2023; DC and four states, including New Jersey, have individual mandate penalties.)
In addition, Governor Murphy signed legislation to protect consumers from surprise balance billing. Here’s a summary of the health care reform legislation New Jersey enacted in 2018:
Horizon Blue Cross Blue Shield — New Jersey’s largest health insurer — began offering new health plans in 2016 that had premiums about 15% lower than the carrier’s 2015 rates, in addition to lower copays and deductibles in exchange for using specified hospitals and providers (as was the case with most plans, premiums for Horizon’s OMNIA plans increased in 2017 and 2018, but continued to be about 10% lower than other similar Horizon plans). Not surprisingly, residents who were polled about the plans expressed support for the concept.
By early 2017, after two years of open enrollment windows in which OMNIA plans were available, Horizon reported that 238,000 people had enrolled in the plans, representing a large majority of the nearly 276,000 individual market Horizon enrollees at that point.
Horizon’s new plans were created under the OMNIA Alliance partnership with 22 hospitals, plus an additional 14 hospitals that are designated “Tier 1.” These 36 hospitals (39 hospitals as of 2018) agreed to accept lower reimbursements in trade for higher volume (since insureds have to use one of those hospitals in order to get the lower copays and deductibles), and also agreed to reimbursement based on quality of care and patient outcomes, rather than fee-for-service reimbursement (it was later confirmed that Horizon favored larger hospitals over smaller hospitals, and that price didn’t play a role in the selection of Tier 1 hospitals).
The other 36 hospitals in New Jersey were designated “Tier 2” under the new plans, and insureds who use those hospitals pay higher copays and deductibles (although insureds still have access to those hospitals, and the hospitals continue to be reimbursed by Horizon if insureds choose to use them). Those hospitals were upset that they were left out, and say they were caught off guard by the new Horizon plans.
A group of 17 Tier 2 hospitals filed a lawsuit in November to stop the OMNIA Alliance, and asked the New Jersey Department of Banking and Insurance (DOBI) to intervene. But the DOBI refused, noting that shuttering the new Horizon plans in the middle of open enrollment – once plans had already been purchased by consumers – would potentially “create significant upheaval and disruption to the New Jersey marketplace and its consumers.” In June 2016, an appeals court ruled against the hospitals, upholding the state’s decision to allow the tiered network plans to be sold. Another lawsuit, brought by seven Tier 2 hospitals, continued until 2018. The case was scheduled to go to trial in October 2018, but Horizon settled with the last plaintiff before the trial began.
Horizon’s approach in New Jersey is a compromise between truly narrow network HMO plans (where enrollees only have coverage at designated facilities) and the broad network PPO plans that dominated the pre-ACA market. Horizon’s CEO has defended the new plans, and noted that in a state where healthcare costs were the second-highest in the country, innovation to lower them is necessary.
Other insurers, including AmeriHealth, have since debuted tiered network plans.
The New Jersey Assembly passed two bills authorizing a state-run exchange in 2012, but both were vetoed by then-Gov. Chris Christie. Those vetoes left the federal government to operate the health insurance marketplace in New Jersey, although that is poised to change under the Murphy Administration. Governor Christie took a very hands-off approach to the ACA, and the state did little to promote the HHS-run exchange under his Administration, leaving most of the heavy lifting to brokers, navigators and HHS.
The state did opt to expand Medicaid however, making health insurance available to hundreds of thousands of low-income residents.
New Jersey Senator Nia Gill introduced the legislation again in 2015 to create a state-run exchange. But her bill, S540, didn’t advance out of committee during the 2015 session. Gill was critical of Gov. Christie’s vetoes of the prior exchange-creation legislation, noting that New Jersey subsidies wouldn’t have been dependent on the outcome of the King v. Burwell case if the state had created its own exchange (subsidies ended up being safe when the Supreme Court ruled that subsidies were legal in every state, not just those that ran their own exchanges).
In January 2014, U.S. Rep Bill Pascrell (D, NJ) introduced a bill that would allow HHS to recoup ACA outreach funding that remains unused by Republican governors like Chris Christie who refused to use the money in their states to promote the ACA and educate residents about its benefits. New Jersey officials were involved in lengthy discussions with HHS over the use of $7.67 million in federal funds that had been granted to NJ in 2012 to use for promoting the state’s health insurance exchange.
The money was intended for outreach, advertising and general promotion of the ACA and the exchange, although NJ officials wanted to use it to staff a call center for the state’s expanded Medicaid program. But HHS had made it clear last year that such a use was not permitted.
Ultimately, the state and HHS were not able to come to a compromise on the issue. New Jersey forfeited the money in February 2015 when the deadline passed, and HHS officially rescinded the funds in May 2015.
New Jersey subsequently decided to move forward with running its own exchange, under legislation that was enacted in 2018 (A.3380). The state first transitioned to a state-based exchange on the federal platform (SBE-FP) in the fall of 2019, and then to a fully state-run exchange (GetCoveredNJ) in the fall of 2020.
New Jersey’s Official Health Insurance Marketplace
State Exchange Profile: New Jersey
The Henry J. Kaiser Family Foundation overview of New Jersey’s progress toward creating a state health insurance exchange.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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