Health insurance in New Jersey
- New Jersey will have a fully state-run exchange — with its own enrollment platform instead of HealthCare.gov — by fall 2020.
- Open enrollment for 2021 health plans has been extended through January 31, 2021 in New Jersey. Outside of open enrollment New Jersey residents need a qualifying event in order to enroll or make changes to their coverage.
- New Jersey has a reinsurance program and an individual mandate that’s enforced via state taxes.
- Three insurers offer coverage in New Jersey’s marketplace.
- As of 2021, state-regulated health insurance plans in NJ will have to cap out-of-pocket prescription costs at no more than $150 per month per drug, in most cases.
- New Jersey’s average individual market premiums decrease for 2019, but increased by almost 9% for 2020.
- Almost 250,000 New Jersey residents enrolled in 2020 coverage through the exchange.
- New Jersey has accepted the ACA’s Medicaid expansion.
- Short-term health plans are not available for purchase in New Jersey.
- New Jersey’s CO-OP, Health Republic Insurance of New Jersey, stopped offering plans in 2017.
This page is dedicated to helping consumers quickly find health insurance resources in the state of New Jersey. Here, you’ll find information about the many types of health insurance coverage available. You can find the basics of the New Jersey health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in New Jersey; an explanation for why there are no short-term health insurance plans in New Jersey; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for New Jersey residents.
New Jersey’s new fully state-run health insurance marketplace
From 2014 through 2020, New Jersey used the federally run exchange, which means residents enrolled in exchange plans through HealthCare.gov. But by the fall of 2020 (for enrollment in 2021 coverage), New Jersey will be running its own health insurance marketplace, with its own enrollment platform. At that point, residents will no longer use HealthCare.gov.
New Jersey residents will instead enroll through GetCoveredNJ. Plans will be available for browsing starting in mid-October 2020, and the state has opted to double the length of the open enrollment period for 2021 coverage.
New Jersey already transitioned to a state-based exchange using the federal enrollment platform (SBE-FP) in the fall of 2019, which means New Jersey has been overseeing the exchange and consumer outreach throughout 2020, while continuing to use HealthCare.gov for enrollments.
New Jersey open enrollment period and dates
Open enrollment for 2021 health plans in New Jersey runs from November 1, 2020 through January 31, 2021. This is among the longest extensions that any state-run exchanges have issued for the upcoming open enrollment period.
Outside of open enrollment, residents need qualifying events in order to enroll or make changes to their medical coverage.
Reinsurance and individual mandate took effect in 2019
New Jersey has a reinsurance program and an individual mandate, both of which took effect in 2019. The reinsurance program, much like similar programs in use in several other states around the country, is designed to keep the individual health insurance market stable and to keep premium increases in check. The individual mandate, which is similar to the one imposed at the federal level by the ACA, requires New Jersey residents to have health insurance. If they don’t, a penalty is imposed when they file their state taxes, unless they qualify for an exemption.
New Jersey law will require state-regulated health plans to cap out-of-pocket prescription costs
A.2431, which was enacted in New Jersey in January 2020, requires state-regulated health plans (ie, not plans that are self-insured) to cap members’ out-of-pocket prescription costs at $150 per month, per prescription (an earlier version of the bill called for the cap to be $100, but that was subsequently amended). Bronze plans can have caps as high as $250/month, and there are exceptions for catastrophic plans and HSA-qualified plans in order to allow those plans to continue to comply with federal requirements.
The cap on out-of-pocket prescription costs applies to both group and individual plans as of January 1, 2021 (for plans that renew on a date other than January 1, the new law applies as of their first renewal after January 1, 2021). The majority of very large businesses self-insure their coverage, and those plans are regulated by the federal government rather than state laws. So A.2431 doesn’t apply to self-insured plans.
New Jersey joins several other states that already have laws in place to cap out-of-pocket prescription drug costs.
Three health insurance companies – AmeriHealth, Horizon BCBS and Oscar Health – offer plans in the New Jersey exchange in 2020. All three will continue to do so in 2021. Oscar’s service area does not include southern New Jersey, so while a resident of the northern part of the state can select from among all three insurers’s plan in 2020, residents in southern New Jersey must choose from between AmeriHealth and Horizon BCBS (both of which have a statewide service area).
New Jersey’s individual market insurers finalized average rate increases for 2020 that ranged from about 6 percent to about 16 percent. This was considerably larger than the rate increases in most states for 2020, but premiums decreased by more than 9 percent in New Jersey in 2019 (while increasing slightly nationwide) and average premiums in New Jersey in 2020 are about $100/month lower than the average across all states that use HealthCare.gov.
For 2021, New Jersey’s three exchange insurers have proposed average rate changes that vary from a small decrease to a double-digit increase:
- AmeriHealth: 11 percent increase
- Oscar: 10.6 percent increase
- Horizon: 1.4 percent decrease
Outside the exchange, Oxford has proposed a 6.8 percent average increase, and Horizon Healthcare of New Jersey, Inc. has proposed an average increase of 9.9 percent.
For 2021, New Jersey will also be offering state-funded premium subsidies for the first time, which will help to keep monthly premiums costs at a more affordable level for people who buy their plans in the New Jersey exchange.
During the open enrollment period for 2020 health coverage, 246,426 New Jersey residents enrolled in individual market health plans through the exchange. That was the third year in a row with a drop in enrollment, mirroring the national trend towards declining enrollment in states that use HealthCare.gov.
Read more about the New Jersey health insurance marketplace.
Medicaid expansion in New Jersey
New Jersey adopted the ACA’s Medicaid expansion and began utilizing federal funding to provide health insurance for the newly eligible population starting in 2014.
As a result, New Jersey’s Medicaid enrollment increased by 35 percent – nearly 450,000 additional people covered – between the fall of 2013 and May 2020. Total Medicaid/CHIP enrollment in New Jersey as of May 2020 stood at more than 1.7 million people. By July 2020, it had grown to more than 1.8 million people. The spike in enrollment mirrors a national uptick in Medicaid enrollment during the COVID pandemic: Many people who were previously employed or running a small business have lost their jobs and potentially their medical insurance coverage as well. And since Medicaid eligibility is based on monthly income, a person who wouldn’t normally be eligible for Medicaid might be temporarily eligible during the pandemic.
Read more about Medicaid expansion in New Jersey.
Short-term health insurance in New Jersey
Despite federal rule changes that rolled back restrictions on short-term health insurance plans as of 2018, these plans are not for sale in New Jersey.
A New Jersey statute that governs individual health insurance plans includes requirements that are not compatible with the short-term plans, so short-term coverage is essentially prohibited in the state – and short-term health plans have not been sold in the state for 25 years.
Read more about short-term health insurance in New Jersey.
How did Obamacare help New Jersey residents?
New Jersey initially opted to let the federal government run its health insurance exchange but expanded Medicaid in 2014. And by October 2020, New Jersey will be running its own exchange platform.
In 2013, according to US Census data, 13.2 percent of New Jersey residents were uninsured. By 2018, that had fallen to 7.4 percent. Across all states, the uninsured rate started out higher than New Jersey – at 14.5 percent – and fell to an average of 8.6 percent by 2016, but had grown slightly, to 8.9 percent, by 2018.
As of 2020, there were nearly 225,000 people enrolled in private health plans through the New Jersey exchange. All of these people have coverage for the ACA’s essential health benefits without lifetime or annual caps on the benefits. Nearly 175,000 of these enrollees are receiving premium subsidies, and nearly 108,000 are receiving cost-sharing reductions. These subsidies make coverage and healthcare less costly and more accessible.
New Jersey’s health insurance CO-OP
Health Republic Insurance of New Jersey was the trade name for Freelancer’s CO-OP of New Jersey, a Consumer Oriented and Operated Plan (CO-OP) established under the ACA. CO-OPs in 22 states received a total of $2 billion in grants from the federal government to establish their programs; Freelancer’s CO-OP of New Jersey received $109 million.
Most of the CO-OPs have since gone out of business; only four remain operational in 2020, and that will drop to three in 2021. New Jersey’s CO-OP was among the seven still in operation as of September 2016. But that month, the NJ Department of Banking and Securities placed Health Republic into rehabilitation and the CO-OP was no longer sell new policies. Existing Health Republic policies terminated at the end of 2016; as a result, nearly 35,000 individuals needed to find new health plans for 2017.
Initially, the hope was that state regulators would be able to stabilize the company enough for it to return to the marketplace in 2018, but that did not come to pass. On February 3, 2017, an order of liquidation for Health Republic was filed. All of the CO-OP’s assets were liquidated to repay creditors to the extent possible.
Medicare enrollment and coverage in New Jersey
As of July 2020, New Jersey Medicare enrollment stood at about 1.63 million people. About 87 percent of New Jersey Medicare beneficiaries qualify based on age alone, while the remaining 13 percent are eligible due to disability.
Read more about Medicare in New Jersey, including availability and enrollment options for Medicare Advantage and Part D plans, and the state’s rules for Medigap plans.
New Jersey Health Insurance Resources
- GetCoveredNJ (new state-run health insurance exchange)
- New Jersey Department of Banking and Insurance, Insurance Division
- New Jersey State Health Insurance Assistance Program (a resource for people with questions about Medicare in New Jersey)
- New Jersey Department of Human Services, Medicaid Office
- Medicare Rights Center (a nationwide resource that can provide information and assistance to people with questions about Medicare benefits and enrollment)
Health care reform legislation in New Jersey
New Jersey has enacted several important pieces of health care reform legislation recently, including:
- S.1878 (2018) — Directed the state to propose a 1332 waiver in order to establish a reinsurance program to stabilize the individual market, using federal funding that would otherwise have been spent on higher premium subsidies. The state received federal approval for the program in 2018 and rolled it out in 2019, with average premiums decreasing by about 9 percent as a result.
- A.2039 (2018) — Protects patients from surprise balance bills if they receive treatment from an out-of-network provider at an in-network facility.
- A.3380 (2018) — Created an individual mandate in New Jersey, effective as of 2019. The penalty for non-compliance is based on the federal individual mandate penalty that applied until the end of 2018, and revenue collected from the penalty will be used to fund the state’s portion of the reinsurance program.
- A.2431 (2019 session, enacted in 2020) — Caps out-of-pocket prescription drug costs at $150 per month per prescription ($250 in the case of Bronze plans) on state-regulated health plans. Effective in 2021.
New Jersey’s legislative session continues throughout the year.
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.