As a New Jersey resident you can choose from health insurance plans offered to individuals and groups by private insurance companies. You may also purchase individual and family coverage from participating private insurers through HealthCare.gov, the federal exchange. If you are self-employed with no employees, you can also use the federal exchange to purchase coverage. You may also be entitled to certain state and federal programs such as Medicaid and COBRA.
The Patient Protection and Affordable Care Act (also known as ObamaCare and the Affordable Care Act and referred to in this guide as ACA) became law in 2010. Provisions of the law have continued to be phased in following passage. As of January 1, 2014, most U.S. citizens and legal residents are required by law to have qualifying health care coverage or pay an annual tax penalty for every month they go without insurance. This is called the “individual mandate.” There is a grace period through March 31, 2014. Beginning in 2014, the penalty for not having qualifying coverage is $95 per adult and $47.50 per child or 1% of your taxable income; whichever is higher (up to $285 per family). The penalty increases annually through 2017 and beyond.
You may be exempt from the individual mandate and tax penalties if:
If you own a small business in New Jersey (50 or fewer full-time-equivalent employees – FTEs), you can purchase qualifying coverage for your employees through SHOP, the Small Business Health Option Program or through a private broker or insurance agent. However, you may qualify for tax credits worth up to 50% of your premium costs if you use SHOP. Beginning in 2016, SHOP will be open to employers with up to 100 FTEs. Under the Employer Shared Responsibility provision of ACA, beginning in 2015, all employers with 50 or more FTEs must offer employees at least one plan that is ACA-compliant or face fines of $2,000 per employee.
Plans offered by private insurers may offer additional benefits and individual states may require additional benefits, but all qualifying plans must offer these 10 standardized essential benefits:
*Lifetime dollar limits on these essential health benefits have been eliminated.
New Jersey currently mandates that the following benefits, which exceed ACA requirements, must be provided or offered by private providers authorized to sell health insurance within the state:
To help you more easily compare costs and benefits, ACA designates that all qualifying plans be one of four metals: Bronze, Silver, Gold and Platinum. Each is based on the average amount of healthcare costs the plan will cover shown as a percentage of what is covered by your insurance company and what is paid for by you. All insurers participating in the federal or a state healthcare exchange must offer , at minimum, Silver and Gold plans. All metal plans have a shared maximum out-of-pocket amount that you can be charged in any calendar year.
| Metal Plan | Insurer Pays | You Pay |
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
Premiums charged for any of the qualifying metal plans may be based on:
Under ACA, no one can be denied coverage or charged significantly higher premiums because of past health history (pre-existing conditions) or gender. There can be no look-back or waiting periods imposed. Policies are effective on issue. All coverage is renewable, if you choose to renew it. Plans can only be canceled for non-payment of premiums or fraud. The guaranteed issue provision applies to all non-grandfathered plans.
You may qualify for financial assistance in the form of tax credits to help with monthly premiums and subsidies to help with out-of-pocket costs.
The following types of health insurance plans are available in New Jersey for individuals and families. They may be purchased through private providers or providers participating in New Jersey through the federal exchange, HealthCare.gov.
New Jersey Department of Banking and Insurance
http://www.state.nj.us/dobi/division_insurance/index.htm
609-292-7272
20 West State Street, P.O. Box 325, Trenton, NJ 08625
Insurance Information Institute
http://www.iii.org
212-346-5000
110 William Street, New York, NY 10038
Federal Healthcare Exchange
http://www.healthcare.gov
1-800-318-2596
Find local in person enrollment assistance
SHOP New Jersey – Healthcare Insurance for Small Businesses
https://www.healthcare.gov/marketplace/shop/#state=New-Jersey
Fast Facts About ObamaCare
http://obamacarefacts.com
New Jersey Health Insurance Guide by E-Insure Services, Inc. is licensed under a Creative Commons Attribution-No Derivative Works 3.0 United States License. Based on a work at www.EINSURANCE.com. Permissions beyond the scope of this license may be available at http://www.EINSURANCE.com/creativecommons/.
