NJ State-Based Exchange Replaces Healthcare.gov for NJ Residents
If you’re in the market for NJ individual health insurance, you’re in luck!
Starting with the 2021 Open Enrollment Period, New Jersey residents no longer are using the Healthcare.gov website to enroll in NJ individual health insurance plans. The new state-based platform GetCovered.nj.gov is now being used.
The GetCovered platform offers several significant advantages over Healthcare.gov:
- Better outreach to NJ residents;
- Statewide access to the NJ individual health insurance market;
- Flexibility to meet the specific needs of NJ residents; and
- More financial help.
GetCovered offers financial help to many New Jerseyans to lower health insurance costs. Applicants may qualify for three types of financial help: premium tax credits, cost-sharing reductions and a new financial assistance program offered by the state of New Jersey. Premium tax credits help lower monthly health insurance premium payments. Cost-sharing reductions help lower out-of-pocket costs, such as deductibles and co-pays. A new state savings program – called “New Jersey Health Plan Savings”- will provide additional help to most people purchasing coverage through GetCovered.
What is the NJ state-based exchange?
The concept of an Exchange for individual health insurance was enabled by the Patient-Protection and Affordable Care Act (PPACA) that the US Congress enacted 3/23/2010. Effective 1/1/2014, each US state was given the option to have its residents utilize the Federal Exchange (Healthcare.gov) or to provide their own state-based exchange.
Initially, NJ chose to use the Federal Exchange, but on 6/29/2019, NJ decided that it would build its own Exchange, for individual health insurance policies effective 1/1/2021.
GetCovered is New Jersey’s official health insurance exchange, where individuals and families can easily shop for and buy coverage. It’s the only place where NJ residents can apply for financial help to lower the cost of monthly insurance premiums and out-of-pocket costs. Additionally, through GetCovered, applicants can learn if they might qualify for free or low-cost health insurance through NJ FamilyCare, New Jersey’s publicly funded health insurance program.
The GetCovered platform is made up of four parts:
- NJ Residents;
- GetCovered Website; and
- NJ Health Insurance Companies.
Through GetCovered health insurance policies, residents obtain access to a network of providers from whom they can obtain the medical care they need. The insurance provides financial protection from the burden of large health care claims, and the insurance satisfies the government requirements that all residents are covered by qualified health insurance.
How do NJ residents use the NJ state-based exchange?
GetCovered has a network of no-cost trained professionals who can answer questions and guide residents through choosing a health plan and applying for coverage. With the help of a licensed agent (e.g. email@example.com 732-591-7234) or assister, a resident will enter household information into their GetCovered account.
Then, the resident can then compare health plans and prices, including determining eligibility for financial help.
The financial comparison includes both the monthly premiums and out-of-pocket costs paid to medical providers.
For each plan, a directory of in-network providers of medical services can be searched. Some of the health plans require the selection of a primary care physician to coordinate care. A plan may or may not require referrals from a primary care physician to go to other providers. Plans are classified as Bronze, Silver or Gold based on their estimated out-of-pocket costs. For example, Bronze plans generally have the most out-of-pocket costs, but the least monthly premium.
Once the desired health plan is determined, an application is submitted via the GetCovered website. GetCovered will usually confirm information in the application automatically, but it’s possible that additional documentation will be required, to support estimated household income or residency, and an applicant can work with their agent to satisfy the application documentation requirements.
Based on the application, an official eligibility letter, including financial help, will be generated.
The applicant pays the first month health insurance premium, and the application is processed by the health insurance company to enroll the applicant into the chosen health insurance policy.
Once enrolled, the health insurance policy can be used to provide access to care and to process claims for medical services such as doctor visits, prescription drugs and emergency care. Some basic and routine care is covered with no out-of-pocket costs.
Open Enrollment using GetCovered is continuing due to the NJ COVID-19 Special Enrollment Period.
NJ residents can get assistance in shopping through the exchange for their health insurance, including from licensed insurance agents (e.g. firstname.lastname@example.org 732-591-7234) or assisters who can provide recommendations:
- Initially on what plans might be most suitable for a resident to choose;
- On an on-ongoing basis, for how a resident can best use the plan throughout the year; and
- How to prepare for the next exchange Open Enrollment.