If you don’t currently have health insurance, there are various ways that the Affordable Care Act (ACA) can provide coverage. These include purchasing an individual plan on an exchange in your state, qualifying for subsidies or enrolling in employer-sponsored policies.
New Jersey law mandates that all residents either purchase health insurance or pay a penalty; this requirement mirrors federal requirements.
Affordable Care Act
The Affordable Care Act (ACA), signed into law in 2010, revolutionized how health insurance is purchased and delivered. It helped stabilize premiums while increasing funding to health centers, eliminating annual and lifetime limits, and giving physicians more control.
The Affordable Care Act made it more difficult for people with preexisting conditions to be denied health insurance and provided more choice and better care – including access to telemedicine and urgent care centers.
At the 2018 session, lawmakers successfully passed and signed into law two important bills that will strengthen New Jersey’s health insurance market. These two laws include an individual mandate and reinsurance program designed to lower costs associated with health insurance premiums.
Health Insurance Exchanges
The Affordable Care Act created Health Insurance Exchanges to assist people in purchasing health coverage. These exchanges are managed either by states – known as State-Based Exchanges or FFEs – or federally by FFEs.
Open Enrollment runs annually between November 1 and January 31, allowing individuals to enroll or switch plans without being subject to any questions from healthcare providers. Most New Jerseyans qualify to purchase coverage through getCoveredNJ, the state-backed health insurance Marketplace.
People eligible for free or low-cost Medicaid coverage may also have options available to them to enroll in Marketplace plans outside the open enrollment period, such as NJ FamilyCare – a publically funded program for low-income families and individuals.
Subsidies
State officials in more and more states are providing financial assistance to people with lower incomes in order to help them afford marketplace coverage. While subsidies typically lower premiums, some also provide cost sharing reductions to cover deductibles and co-pays.
New Jersey residents may qualify for three forms of financial help based on their income: premium tax credits, cost-sharing reductions and NJ Health Plan Savings. Residents can use GetCoveredNJ’s “Shop and Compare” tool to check if they qualify and apply online if applicable.
State subsidies can help increase affordability, but they must remain adaptable enough to respond quickly to new information or policy shifts that arise. Statutory laws pertaining to state subsidies should provide for an adaptable operational system with an eye toward how future operational choices affect flexibility in 2022 and beyond.
State-based premium subsidies present one of the biggest obstacles to consumer affordability; particularly for families, undocumented individuals and younger consumers who do not qualify for subsidies such as PTC coverage or similar schemes.
Enrollment
Enrollment is the process of purchasing or changing health insurance coverage for yourself or your family in New Jersey. All New Jerseyans who meet eligibility requirements can enroll.
New Jerseyans now have access to financial help from the government that can reduce the costs of health care plans. More people than ever were eligible for assistance during this year’s enrollment period.
More than 9 out of 10 New Jerseyans who enroll at Get Covered New Jersey qualify for federal or state subsidies to lower their costs, thanks to the 2021 American Rescue Plan as well as state subsidies known as NJ Health Plan Savings beginning in 2023. This increased financial help is possible thanks to these plans’ provisions of financial relief for enrollees.
New Jersey’s market has historically been extremely stable and performed admirably, yet several factors may negatively impact it in 2019. Chief among them are the loss of the federal individual mandate penalty; proposed federal rules for association health plans; and any potential changes to MEC (medically essential coverage).
