New Jersey Health Insurance

Health insurance in New Jersey

● New Jersey will have a fully state-run exchange - with its own registration platform instead of HealthCare.gov - by fall 2020.

● Open enrollment for 2021 health plans has been extended until January 31, 2021 in New Jersey. Outside of open enrollment, New Jersey residents need a qualifying event to enroll or make changes to their coverage.

● New Jersey has a reinsurance program and an individual mandate that is imposed through state taxes.

● Three insurers offer coverage in the New Jersey market.

● Starting in 2021, state-regulated health insurance plans in NJ will have to limit out-of-pocket prescription costs to no more than $150 per month per drug, in most cases.

● New Jersey's average individual market premiums fall for 2019, but have increased by nearly 9% for 2020.

● Nearly 250,000 New Jersey residents signed up for 2020 coverage through the exchange.

● New Jersey has accepted the ACA's Medicaid expansion.

● Short-term health plans are not available for purchase in New Jersey.

● New Jersey CO-OP, Health Republic Insurance of New Jersey, stopped offering plans in 2017.

This page is dedicated to helping consumers quickly find health insurance resources in the state of New Jersey. Here you will find information about the many types of health insurance coverage available. You can find the basics of the New Jersey health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in New Jersey; an explanation of why there are no short-term health insurance plans in New Jersey; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for New Jersey residents.

New Jersey's health insurance marketplace

From 2014 to 2020, New Jersey used federally managed exchange, meaning residents signed up for exchange plans through HealthCare.gov. But by fall 2020 (for enrollment in 2021 coverage), New Jersey is running its own health insurance market, with its own registration platform. At that point, residents will no longer use HealthCare.gov.

New Jersey residents will register via GetCoveredNJ instead. Plans will be available for navigation starting in mid-October 2020, and the state has chosen to double the duration of the open enrollment period for 2021 coverage.

New Jersey has already switched to a state-based exchange using the federal registration platform (SBE-FP) in the fall of 2019, meaning New Jersey has overseen consumer exchange and awareness throughout 2020, continuing to use HealthCare.gov for enrollment.

Open enrollment period and dates in New Jersey

Open enrollment for 2021 health plans in New Jersey runs from November 1, 2020 to January 31, 2021. This is one of the longest extensions that all state-managed exchanges have issued for the next open registration period.

Outside of open enrollment, residents need qualified events to enroll or make changes to their medical coverage.

Reinsurance and individual mandate are effects in 2019

New Jersey has a reinsurance program and an individual mandate, both of which take effect in 2019. The reinsurance program, just like similar programs in use in many other states across the country, is designed to keep the individual health insurance market stable and to keep premiums under control. The individual mandate, which is similar to the one imposed federally by the ACA, requires New Jersey residents to have health insurance. In the event of non-application, a penalty is imposed when inflicting state taxes, unless they are entitled to an exemption.

New Jersey law will require state-regulated health plans to limit out-of-pocket prescription costs

A.2431, which was enacted in New Jersey in January 2020, requires state-regulated health plans (i.e. not plans that are self-insured) to limit members' out-of-pocket prescription costs to $150 per month, per prescription (an earlier version of the bill required the cap to be $100, but which was later amended). Bronze plans can have ceilings of up to $250 per month, and there are exceptions for catastrophic plans and HSA-qualified plans in order to allow those plans to continue meeting federal requirements.

The out-of-pocket prescription cost cap applies to both group and individual plans as of January 1, 2021 (for plans that renew on a date other than January 1, the new law applies from their first renewal after January 1, 2021). Most large companies self-secure their coverage, and these plans are regulated by the federal government rather than state laws. So A.2431 does not apply to self-insured plans.

New Jersey joins many other states that already have laws in place to limit the cost of pocket prescription drugs.

New Jersey Market: Insurers, Rates, and Enrollments

Three health insurance companies - AmeriHealth, Horizon BCBS and Oscar Health - offer plans in the New Jersey exchange in 2020. All three will continue to do so in 2021. Oscar's service area doesn't include southern New Jersey, so while a resident of the northern part of the state can choose from all three insurers' plans in 2020, Southern New Jersey residents must choose between AmeriHealth and Horizon BCBS (both have a state-wide service area).

Individual New Jersey market insurers finalized average rate increases for 2020 ranging from about 6 percent to about 16 percent. This was considerably larger than rate increases in most states for 2020, but premiums fell by more than 9% in New Jersey in 2019 (while they are rising slightly nationally) and average premiums in New Jersey in 2020 are about $100/month below average in all states using HealthCare.gov.

For 2021, New Jersey's three foreign exchange insurers have proposed average rate changes ranging from a small decrease to a double-digit increase:

● AmeriHealth: 11% increase

● Oscars: 10.6% increase

● Horizon: down 1.4%

Outside of the exchange, Oxford proposed an average increase of 6.8% and Horizon Healthcare of New Jersey, Inc.

By 2021, New Jersey will also offer state-funded premium subsidies for the first time, which will help keep monthly premium costs at a more affordable level for people buying their plans in the New Jersey exchange.

During the open enrollment period for 2020 health coverage, 246,426 New Jersey residents enrolled in individual market health plans through the exchange. It was the third year in a row with a decline in enrolments, reflecting the national trend toward declining enrollment in states that use HealthCare.gov.

Medicaid expansion in New Jersey

New Jersey adopted the ACA's Medicaid expansion and began using federal funding to provide health insurance for the newly eligible population starting in 2014.

As a result, New Jersey Medicaid enrollment increased by 35% - nearly 450,000 additional people covered - between fall 2013 and May 2020. Total Medicaid/CHIP enrollment in New Jersey in May 2020 amounted to more than 1.7 million people. By July 2020, it had grown to more than 1.8 million people. The spike in enrollment reflects a national increase in Medicaid enrollment during the COVID pandemic: many people who were previously employed or run a small business lost their jobs and potentially even medical insurance coverage. And because Medicaid eligibility is based on monthly income, a person who would not normally be eligible for Medicaid could be temporarily eligible during the pandemic.

Short-term health insurance in New Jersey

Despite changes to federal rules that reinstated restrictions on short-term health insurance plans in December 2018, these plans are not for sale in New Jersey.

A New Jersey statute governing individual health insurance plans includes requirements that are not compatible with 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.

How did Obamacare help New Jersey residents?

New Jersey initially chose to let the federal government manage its health insurance exchange, but expanded Medicaid in 2014. And by October 2020, New Jersey will launch its own exchange platform.

In 2013, according to U.S. Census data, 13.2% of New Jersey residents were un insured. By 2018 it had fallen to 7.4%. In all states, the uns insured rate started higher than New Jersey - at 14.5 percent - and fell to an average of 8.6 percent by 2016, but had grown slightly, to 8.9 percent, by 2018.

As of December 2020, there were nearly 225,000 people enrolled in private health plans through the New Jersey exchange. All of these people have coverage for the ACA's essential health benefits with no life limits or annual benefits. Almost 175,000 of these members receive grants for the prize and nearly 108,000 receive cost-sharing reductions. These subsidies make coverage and health care less expensive and more affordable.

New Jersey Health Insurance Co-OP

Health Republic Insurance of New Jersey was the trade name of Freelancer's New Jersey CO-OP, a consumer-oriented and managed plan (CO-OP) established under the ACA. CO-DOs in 22 states received a total of $2 billion in grants from the federal government to establish their programs; Freelancer's New Jersey CO-OP received $109 million.

Since then, most CO-Po's have failed; only four remain operational in 2020, and this will fall to three in 2021. The New Jersey CO-OP was among seven still in operation in September 2016. But that month, the NJ's Department of Banks and Securities put the Health Republic in rehab and CO-OP no longer sold new policies. The current policies of the Health Republic ended at the end of 2016; as a result, nearly 35,000 people needed to find new health plans for 2017.

Initially, the hope was that state regulators would be able to stabilize the company enough to return to the market in 2018, but that didn't happen. On 3 February 2017, a winding-up order was filed for the Health Republic. All co-op assets have been liquidated to repay creditors as far as possible.

Medicare enrollment and coverage in New Jersey

As of July 2020, enrollment in New Jersey Medicare was about 1.63 million people. About 87% of New Jersey Medicare beneficiaries qualify by age, while the remaining 13% are eligible due to disability.

New Jersey Health Insurance Resources

● GetCoveredNJ (new 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 benefits and Medicare enrollment)

Health care reform legislation in New Jersey

New Jersey has recently enacted several important health care reform legislation, 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 implemented it in 2019, with average premiums down about 9%.

● A.2039 (2018) — Protects patients from surprise bills if they receive care from an off-network provider in a networked facility.

● A.3380 (2018) — Created an individual mandate in New Jersey, effective 2019. The penalty for non-compliance is based on the sanction of the federal individual mandate applied until the end of 2018, and the revenue collected from the penalty will be used to finance the state part of the reinsurance program.

● A.2431 (2019 session, promulgated in 2020) - Caps out-of-pocket prescription costs at $150 per month per prescription ($250 in the case of Bronze plans) on state-regulated health plans. In force in 2021.