Frequently asked questions about health insurance
coverage options in New Jersey
New Jersey runs its own health insurance exchange, so residents enroll in coverage through GetCoveredNJ.
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.
With its new flexibility to set a different enrollment deadline once it no longer relied on HealthCare.gov, New Jersey opted to double the length of the open enrollment period for 2021 coverage, and extended its COVID/American Rescue Plan enrollment period through the end of 2021 (in states that use HealthCare.gov, it ended August 15, 2021).
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. But it wasn’t until the state began fully running its own exchange that they had the flexibility to extend enrollment windows.
Open enrollment for individual/family health coverage in New Jersey runs from November 1 through January 31. 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 generally need a qualifying event in order to enroll or make changes to their medical coverage.
Learn more about enrollment opportunities in our comprehensive guides:
In New Jersey, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.
New Jersey residents may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in New Jersey.
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:
- Horizon Healthcare Services (BCBS)
- Oscar Health
- Ambetter from WellCare of New Jersey
- Aetna (new for 2023)
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).
For 2023, average premiums in the individual market in New Jersey increased by 8.8%, with the following average rate changes for each insurer:
- AmeriHealth: 7.8% increase
- Horizon Healthcare Services (BCBS): 9.4% increase
- Oscar Health: 6.7% decrease
- WellCare/Ambetter: 5.4% increase
- Aetna: New for 2023, so no applicable rate change.
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. In addition to federal subsidies, New Jersey also offers state-funded subsidies that further reduce the cost of coverage for most enrollees (the state-funded subsidies debuted in 2021).
During the open enrollment period for 2022 health coverage, 324,266 New Jersey residents enrolled in individual market health plans through the exchange. This was a record high, as was the case in most states for 2022. The higher enrollment was driven in large part by the American Rescue Plan’s subsidy enhancements, which made subsidies larger and more widely available starting in mid-2021.
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 early 2022, more than 324,000 people were enrolled in 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. More than 280,000 of these enrollees were receiving federal premium subsidies, and more than 155,000 were receiving cost-sharing reductions.
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 since been expanded to 600% of the poverty level.
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 850,000 additional people covered – between the fall of 2013 and mid-2022. Total Medicaid/CHIP enrollment in New Jersey as of June 2020 stood at more than 2.1 million people.
This represented a significant amount of growth since 2020, mirroring a national uptick in Medicaid enrollment during the COVID pandemic. Under the Families First Coronavirus Response Act, enacted in March 2020, states are receiving additional federal Medicaid funding during the pandemic, but on the condition that Medicaid enrollees not be disenrolled until after the end of the COVID public health emergency (PHE). The PHE is expected to continue until at least April 2023; once it ends, regular Medicaid eligibility redeterminations will resume, after being paused for at least three years.
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 mid-2022, New Jersey Medicare enrollment stood at about 1.68 million people. About 90% of New Jersey Medicare beneficiaries qualify based on age alone, while 10% are under 65 and 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% 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.
Yes. New Jersey implemented an individual mandate in 2019, with a penalty modeled on the ACA’s penalty.
The penalty is capped at the cost of the statewide average annual premium for Bronze Health Plans in New Jersey.