New Jersey Health Insurance Consumer Guide

To be eligible to enroll in private health coverage through GetCoveredNJ, you must:⁵

• Live in New Jersey and be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

So most New Jersey residents are eligible to enroll in a health plan through the exchange.⁶ But a bigger question for most people is eligibility for financial assistance, and there are some additional parameters must be met in order to qualify for state and federal subsidies through GetCoveredNJ. 

To qualify for income-based Advance Premium Tax Credits (APTC), federal cost-sharing reductions (CSR), or New Jersey’s Health Plan Savings subsidies, you must:

• Not be eligible to enroll in an affordable plan offered by an employer. If you have access to an employer’s plan and aren’t sure whether it’s considered affordable, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies via GetCoveredNJ. 
• Not be eligible for New Jersey Family Care (Medicaid or CHIP), or for premium-free Medicare Part A.⁷
• If married, file a joint tax return⁸ (with very limited exceptions)⁹
• Not be able to be claimed by someone else as a tax dependent.¹⁰

In addition to those basic parameters, qualifying for subsidies through GetCoveredNJ depends on your household’s income and how that compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location.

In New Jersey, the open enrollment period begins November 1 and continues through January 31.¹¹ This is a couple weeks longer than the enrollment window used in most other states. 

For coverage to take effect on January 1, your application needs to be completed by December 31,¹² which is later than the deadline in most other states.¹³ In New Jersey, if you enroll in January, your new coverage will take effect on February 1. 

Outside of the annual open enrollment period, you may be eligible to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage.

New Jersey is one of several states where pregnancy is considered a qualifying life event, allowing a pregnant woman to enroll in health coverage during the pregnancy (in most states, the birth of a baby is a qualifying event, but pregnancy is not).¹⁴

New Jersey enacted legislation to create an “easy enrollment” program that became available in early 2024, helping uninsured people get connected with health coverage via their state tax returns. ¹⁵

And some people can enroll year-round even without a specific qualifying life event.

Enrollment in New Jersey Family Care (Medicaid and CHIP) is available year-round.

To enroll in an ACA Marketplace/exchange plan in New Jersey, you can: 

• Visit GetCoveredNJ, New Jersey’s health insurance exchange, to compare available health plans, determine whether you’re eligible for financial assistance (including federal and state subsidies), and enroll in coverage, either during open enrollment or during a special enrollment period. 
• Enroll in a GetCoveredNJ plan the help of licensed agents, navigators, or certified application counselors.¹⁶
  

You can reach GetCoveredNJ’s call center at 1-833-677-1010 TTY 711

As a result of the Affordable Care Act (ACA), federal income-based subsidies (APTC) are available to lower the amount you pay for your health coverage each month. These subsidies are available to enrollees who meet the eligibility requirements and select a metal-level health plan through GetCoveredNJ.

Eighty-eight percent of the people who enrolled via GetCoveredNJ during the open enrollment period for 2024 coverage were eligible for advance premium tax credits. These subsidies paid an average of $521/month, reducing the average subsidized enrollee’s premium to about $156/month.¹⁷

Source: CMS.gov¹⁸

In addition, New Jersey is among the states where additional state-funded subsidies are available. The New Jersey Health Plan Savings subsidies are available to enrollees with household incomes up to 600% of the federal poverty level. (For 2024 coverage, that’s $87,480 for a single individual, and $180,000 for a family of four.)¹⁹

The state-funded subsidies are added on top of the federally-provided APTC, further reducing the amount that people have to pay for their health coverage in New Jersey.

Applicants with household income up to 250% of the federal poverty level are also eligible for federal cost-sharing reductions (CSR), which reduce the deductible and other out-of-pocket expenses for Silver-level plans. More than half of GetCoveredNJ enrollees were receiving CSR benefits as of 2024.¹⁷

If you’re eligible for premium subsidies (including APTC and NJ Health Plan Savings subsidies) as well as CSR, you can use them both if you select a Silver-level plan through GetCoveredNJ. (APTC and NJ Health Plan Savings subsidies can be used with plans at any metal level, but CSR benefits are only available on Silver plans.) 

Although most GetCoveredNJ enrollees do qualify for premium subsidies, New Jersey is also among the states that have created reinsurance programs. This helps to keep unsubsidized premiums lower than they would otherwise be.²⁰

Depending on your income and circumstances, you may be able to enroll in free or low-cost health coverage through New Jersey Family Care. Learn more about whether you might be eligible for these programs in New Jersey.

Six insurers offer plans through New Jersey’s exchange for 2024, including one newcomer.²¹ All six insurers will continue to offer Marketplace plans in New Jersey in 2025.²

For 2025, New Jersey’s Marketplace insurers have proposed the following average rate changes, applicable to full-price premiums (ie, before subsidies are applied). The rates are under review by the NJ Department of Banking and Insurance, and will be finalized before open enrollment begins in November 2024.

Source: RateReview.HealthCare.gov²

In addition, AmeriHealth HMO, which only offers off-exchange plans, has proposed an average rate increase of 3.76% for 2025 (premium subsidies cannot be used with off-exchange plans).

Average rate changes apply to full-price premiums. But most enrollees qualify for advance premium tax credits (subsidies) and thus do not pay full price.

These subsidies are larger and more widely available than they used to be, due to the American Rescue Plan and the Inflation Reduction Act.²²

For perspective, here’s an overview of how average unsubsidized premiums in the individual market in New Jersey have changed over the years:

• 2015: Average increase of 2%²³
• 2016: Average increase of 10.2%²⁴
• 2017: Average increase of 8.8%²⁵
• 2018: Average increase of 22%²⁶
• 2019: Average decrease of 9.3%²⁷ (Reinsurance program took effect)
• 2020: Average increase of 8.7%²⁸
• 2021: Average increase of 3.3%²⁹
• 2022: Average increase of 7.9%³⁰
• 2023: Average increase of 8.8%³¹
• 2024: Average increase of 4.4%³² 

During the open enrollment period for 2024 coverage, 397,942 people signed up for private plans through GetCoveredNJ.¹⁷ This was a new record high for the state, for the third year in a row.

The enrollment growth is due partly to the enhancement of premium subsidies under the American Rescue Plan and Inflation Reduction Act, New Jersey’s additional state subsidy program, and the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in 2023 after a three-year pause. By April 2024, more than 48,000 New Jersey residents had transitioned from Medicaid to a Marketplace plan.³³

Source: 2014,³⁴ 2015,³⁵ 2016,³⁶ 2017,³⁷  2018,³⁸ 2019,³⁹ 2020,⁴⁰ 2021,⁴¹ 2022,⁴² 2023,⁴³ 2024⁴⁴

GetCoveredNJ (also called Get Covered New Jersey)
New Jersey’s Marketplace/exchange. Residents who need to buy their own health insurance can use GetCoveredNJ to enroll in coverage and receive income-based subsidies. You can contact GetCoveredNJ at r 1-833-677-1010 TTY 711.

New Jersey Division of Insurance
Regulates New Jersey’s insurance industry, and assists consumers and businesses with insurance-related questions and concerns.

New Jersey Family Care
Includes Medicaid and the Children’s Health Insurance Program (CHIP).

New Jersey State Health Insurance Assistance Program
A resource for people with questions about Medicare in New Jersey.