Frequently asked questions about health insurance
coverage options in New Jersey
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 was running its own health insurance marketplace, with its own enrollment platform.
So New Jersey residents no longer use HealthCare.gov. Instead, they enroll through GetCoveredNJ. With its new flexibility to set a different enrollment deadline, the state opted to double the length of the open enrollment period for 2021 coverage, and has extended its COVID/American Rescue Plan enrollment period through the end of 2021 (in states that use HealthCare.gov, it runs through August 15).
New Jersey had already transitioned to a state-based exchange using the federal enrollment platform (SBE-FP) in the fall of 2019, which means New Jersey was overseeing the exchange and consumer outreach throughout 2020, while continuing to use HealthCare.gov for enrollments.
Open enrollment for 2022 health coverage in New Jersey runs from November 1, 2021 through January 31, 2022. This is a couple weeks longer than the open enrollment period in most states; New Jersey has the ability to extend open enrollment because the state runs its own exchange.
Outside of open enrollment, residents normally need qualifying events in order to enroll or make changes to their medical coverage. But to address the ongoing COVID pandemic and the additional subsidies that are available as a result of the American Rescue Plan, GetCoveredNJ is allowing uninsured residents an extended window, through December 31, 2021, during which they can enroll in a health plan without needing a qualifying event.
The COVID-related enrollment window in New Jersey overlaps with open enrollment for 2022 coverage, which starts on November 1, 2021. But people who use the COVID-related enrollment window in November 2021 will have coverage effective in December, whereas those who enroll using the open enrollment period will have coverage effective January 2022.
For 2022 coverage, four insurers offer plans through New Jersey’s exchange. This includes WellCare, which is new for 2022, along with the three insurers that already offered plans as of 2021. For 2022 coverage, plans are available in New Jersey’s exchange from the following insurers:
- Horizon Healthcare Services (BCBS)
- Oscar Health
- Ambetter from WellCare of New Jersey (new for 2022)
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).
New Jersey’s individual market insurers finalized average rate changes that amounted to a 3.3% increase for 2021:
- AmeriHealth: roughly 6.5% increase
- Horizon Healthcare Services (BCBS): 1.1% increase
- Oscar Health: 6.1% increase
- Oxford (UnitedHealthcare), only available outside the exchange: 10.4% average increase
For 2021, New Jersey is also offering state-funded premium subsidies for the first time, which are helping 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 2021 health coverage, 269,560 New Jersey residents enrolled in individual market health plans through the exchange. That was an increase of more than 9% from the year before, after three consecutive years of decreasing enrollment (mirroring the national trend towards declining enrollment from 2017 through 2020 in states that use HealthCare.gov).
And enrollment is likely to continue to increase in early 2021, during the COVID-related enrollment period that GetCoveredNJ is offering.
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 was running its own exchange platform.
In 2013, according to US Census data, 13.2% of New Jersey residents were uninsured. By 2018, that had fallen to 7.4%, although it grew to 7.9% by 2019. Across all states, the uninsured rate started out higher than New Jersey – at 14.5% – and fell to an average of 8.6% by 2016, but had grown to 9.2% percent by 2019.
As of 2020, there were nearly 225,000 people with effectuated private health plans through the New Jersey exchange. All of these people had coverage for the ACA’s essential health benefits without lifetime or annual caps on the benefits. Nearly 175,000 of these enrollees were receiving premium subsidies, and nearly 108,000 were receiving cost-sharing reductions.
These subsidies make coverage and healthcare less costly and more accessible, and the American Rescue Plan has made them larger and more widely available in 2021 than they’ve been in past years.
New Jersey is also offering its own state-based premium subsidies as of 2021, which are provided in addition to the federally-provided subsidies. These subsidies were initially only available to people earning up to 400% of the poverty level, but they’ve been expanded to 600% of the poverty level as of May 2021.
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 46% – More than 590,000 additional people covered – between the fall of 2013 and November 2020. Total Medicaid/CHIP enrollment in New Jersey as of November 2020 stood at nearly 1.9 million people. This represented a significant amount of growth in 2020, mirroring 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.
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.
As of December 2020, New Jersey Medicare enrollment stood at about 1.64 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.
- GetCoveredNJ (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)
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.
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.