Welcome to the fastest way to find out about Obamacare in New Jersey.
Here, you'll find clear and accurate information about Obamacare, including:
whether or not you must get health insurance
what the available plans cover
how much coverage will cost
how to sign up for a plan, and
how to get help if you need it.
To begin, keep in mind these key points about Obamacare in New Jersey:
1. You are legally required to have health insurance, unless you qualify for an exemption.
The Affordable Care Act requires you to enroll in a health insurance plan unless you qualify for an exemption from the law. You must report whether you have coverage -- or whether you are exempt -- when you file your taxes in April.
Despite what you may have heard, you can’t be arrested or thrown in jail if you don’t have health insurance in New Jersey. You may, however, be forced to pay a tax penalty if you aren't enrolled in a health insurance plan that meets the requirements of the Affordable Care Act.
To avoid the penalty, you must either obtain qualified health coverage or prove your eligibility for an exemption.
What Qualifies as Coverage?
If you have any of the following types of health coverage, you won’t have to pay a penalty:
an individual insurance plan, whether purchased on your own or through HealthCare.gov, the exchange serving New Jersey
a plan (including COBRA or a retiree plan) provided by your employer
Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP) more...
This article explains the costs of health care plans offered under Obamacare (the Affordable Care Act) for individuals or families who are currently uninsured or not covered by a job-based health plan.
What you'll pay for an Obamacare plan depends on five things:
The level of coverage you choose
Whether you qualify for a subsidy
Where you live in New Jersey
Whether you smoke
Read on to learn more about each of these factors.
1. The Level of Coverage You Choose
Obamacare insurance plans offer four levels of coverage, commonly called "metal levels":
The easiest way to sign up for a health plan under the Affordable Care Act is to go to the online health insurance marketplace for New Jersey. If you're not ready to enroll right now, you can get more information online, over the phone, or in person.
Where's the New Jersey Health Care Exchange?
You can find the health insurance exchange for New Jersey at HealthCare.gov. This is where you can learn about the various health insurance options available to you under Obamacare. If you see a plan you like, you'll be guided through the enrollment process online.
You might not see any mention of Obamacare or the Affordable Care Act when you visit the exchange website, but rest assured you’ve landed in the right place. The exchange was established solely for the purpose of informing consumers about the Affordable Care Act and providing plans under the law.
As Obamacare enters its fourth open-enrollment period, one would hope the health insurance application process would be as simple and fast as it was originally intended to be. But, for many, streamlined health plan enrollment and renewal -- not to mention truly affordable coverage -- still seems like a faraway goal.
Below are a couple strategies to keep your application moving forward and get your health insurance needs met.
Common Complaints from Health Insurance Applicants
The list of complaints from those caught in the health exchange bureaucracy is long, commonly including:
exchange websites are still buggy or broken
phone and chat hold times are unreasonable, and representatives often don’t have helpful answers to questions
applicants can’t easily compare health plan benefits and costs
applicants can’t figure out whether their current health care providers are included in the plan they’re considering
applicants choose plans only to discover later that they can’t afford them
application information isn’t recorded properly (or protected from privacy violations) by the health care exchange
exchanges are slow to respond to problems with applications, premium payments, or tax forms, and
health insurance plans are sometimes canceled or changed without notice.
Do you have to worry about new IRS Forms 1095, 8965, or 8962? The Affordable Care Act, aka Obamacare, requires almost everyone to do one of the following three things when they file their taxes this year:
confirm they had health insurance coverage for 2015
claim an exemption from health coverage, or
pay a penalty when when they file their return.
For some people, complying with the Affordable Care Act will mean filling out new tax forms. Fortunately, that’s not true for most folks -- and even those who need assistance with Obamacare’s new tax rules can get help.
Here’s what you should know about filing your taxes in the era of health care reform.
Get a colonoscopy, mammogram, vaccinations, and other essential services for free
The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through HealthCare.gov, the health care marketplace for New Jersey. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.
Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges
Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.
Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.
Know the difference between “preventive” and “diagnostic.” Doctors can use screening tests for either preventive or diagnostic reasons. For example, having a routine mammogram every year or two is preventive care for women over 40. But if you schedule a mammogram because you feel a lump or have breast pain, that’s diagnostic. Likewise, a routine colonoscopy is recommended for adults over 50, but if your doctor schedules a colonoscopy to investigate a problem like blood in your stool, it becomes a diagnostic procedure. Preventative services are free; diagnostic procedures are not. (If the timing is right -- say, you go to the doctor because you find a lump in your breast but you also happen to be due for an annual mammogram -- your doctor may bill the diagnostic procedure as preventive, but that’s not something you can count on.)
One way to satisfy Obamacare’s health insurance requirement is to obtain coverage under Medicaid. If you qualify for Medicaid and enroll in New Jersey's Medicaid program, you do not have to sign up for another insurance plan.
It’s Now Easier to Qualify for Medicaid in New Jersey
The Affordable Care Act expanded Medicaid eligibility to cover more people who can’t afford health insurance. The U.S. Supreme Court later decided that it was up to individual states to decide whether or not to expand Medicaid.
Because New Jersey did decide to expand its Medicaid program, you can qualify for Medicaid if you earn up to 138% of the federal poverty level. For 2015, 138% of poverty level is about $16,240 for an individual or $33,460 for a family of four.
Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest hassles they face. But this may change for the better under Obamacare, which provides new coverage options for the self-employed.
Are You Self-Employed or an Employer?
Before you start evaluating your options for health coverage, you need understand whether you are in fact considered self-employed under Obamacare.
The law says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) Self-employed people can use the new health care marketplace to purchase individual health insurance plans.
If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace.
The difficulties of unemployment are often compounded by the lack or loss of health insurance. But millions of Americans who are currently without both a job and health coverage may find relief under Obamacare. That's because new coverage options are now available through HealthCare.gov, the health insurance marketplace serving New Jersey.
All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, as an unemployed person, you probably qualify for significant cost-saving subsidies.
When you sign up for a marketplace health plan, your coverage can start within a few weeks. Usually, you must sign up during an open enrollment period. (For 2016, open enrollment ends on January 31.) But leaving your job and losing job-based health insurance makes you eligible for a special enrollment period. That means you'll have 60 days to sign up for a new health plan.
Here's an overview of your options for health insurance if you are unemployed, plus more information about what might happen if you don't get health coverage. (And if you're looking for information about applying or eligibility for unemployment, see our articles on New Jersey unemployment benefits.)
When registered domestic partners or civil union partners apply for coverage in the new health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes, or must we include all the income we make as a couple?
The answer depends on the state where you live.
States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)
California, Nevada, or Washington. In these states, which extend community property laws to registered domestic partners, domestic partners must usually apply using half of the partners’ combined incomes. (We confirmed this with the legal department at Covered California after repeatedly receiving conflicting information from representatives staffing the exchange’s customer service phone line.) This is because IRS rules require that domestic partners registered in these community property states report half of their combined community income on their federal taxes each year.
The U.S. Supreme Court has upheld health care subsidies for residents of New Jersey and other states that rely on HealthCare.gov, the federal government’s health insurance exchange. As described below, King v. Burwell could have ended tax-credit subsidies for states that use the federal marketplace to facilitate the purchase of health insurance plans under Obamacare.
The 6-3 ruling means that almost 6.5 million Americans will continue to receive the financial assistance that helps them afford health insurance.
All health plans purchased through the HealthCare.gov, the health insurance marketplace for New Jersey, must include the following benefits. These are known under Obamacare as “essential health benefits”:
Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)
Hospitalization (including surgery)
Maternity and newborn care
Mental health and substance use disorder services (including counseling and psychotherapy)
Rehabilitative and habilitative services and devices (for people with injuries, disabilities, or chronic conditions, to strengthen their mental and physical skills)
Preventive and wellness services and chronic disease management
Pediatric services (including oral and vision care)
Companies that offer plans through a state exchange will compete on price and quality of service in delivering these benefits.
Am I exempt from Obamacare?
Under Obamacare, most people who don't have health insurance will be required to pay a tax penalty. But you may not have to pay if you qualify for one or more of the following exemptions:
You are uninsured for fewer than three months of the year.
You prove that you can’t afford coverage -- that is, premiums for the least-expensive policy cost more than 8% of your earnings.
You don’t have to file a federal income tax return because your income is too low.
You are a member of a federally recognized Indian tribe.
You are a member of a health care sharing ministry.
You are a member of a recognized religion that objects to health insurance.
You are in the United States illegally.
You are incarcerated.
You may be eligible for an exemption under other circumstances, as well -- for example, if you can show that obtaining coverage would subject you to serious financial hardship.
If you used the marketplace to purchase a plan last year. Most people who purchased their 2015 insurance plan from an online marketplace will be able to automatically renew their coverage for 2016. While automatic renewal sounds convenient, it has serious downsides:
If your insurer decides to cancel your current plan, you could be switched to another plan without warning. The new plan may cost you more or change your eligibility for financial assistance.
Automatic re-enrollment could mean you aren't getting the right subsidy package. That could leave you facing higher monthly premiums now or -- if you take more assistance than you're eligible for -- a big tax bill later.
You may miss out on a better deal or better coverage if you don't compare all available plans to your current plan.
While allowing yourself to be automatically re-enrolled is better than going without insurance, it's best to take advantage of open enrollment and research your options. Shop around and evaluate new plans and costs. Even if you decide to stay with the plan you have, you can use open enrollment to confirm your personal information and ensure you're getting the right amount of financial aid.
If you purchased an individual or family insurance plan outside the online marketplace. As long as the plan meets Obamacare's coverage requirements, you can keep it. Or, you may use HealthCare.gov to compare plans and replace it. If you keep your current plan, you won't be eligible for the cost-saving subsidies available for plans purchased through the exchange.
Be sure to check with your current insurance provider before canceling a health insurance policy; you may have to wait until the end of your current policy year to make a change.
If you have insurance through an employer. As long as you're happy with your plan, you can keep it. You're considered covered under Obamacare. On the other hand, if you're not satisfied with the coverage you have, you may be able to switch to an individual plan through HealthCare.gov.
Keep in mind that if you buy a plan through the exchange:
Your employer will not have to pay a portion of your monthly premiums.
You may not qualify for cost-saving subsidies, even if your income falls within the eligible range. If your employer offers coverage that is considered affordable and sufficient under the law, you won't qualify to save on premiums or out-of-pocket costs for plans purchased through HealthCare.gov.
What is the health insurance marketplace?
The health insurance marketplace (sometimes called an "exchange") is where to go to get health insurance under the Affordable Care Act. The marketplace for New Jersey is HealthCare.gov. You can use the marketplace to compare plans, learn whether you qualify for cost-saving subsidies, and sign up for the plan that works best for you.
Where can I get in-person help with my application?
In New Jersey, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from a trained “navigator” or certified application counselor.
Navigators and certified counselors aren’t allowed to recommend a plan for you. Rather, they can explain your options, answer your questions, and help you apply for the plan you choose.
Private insurance agents or brokers can also help you understand your health care coverage options under Obamacare. Unlike government-trained navigators and counselors, they are allowed to suggest the best plan for you.
To find a navigator or certified application counselor in New Jersey, go to Find Local Help at HealthCare.gov. There, you can enter your city and state or zip code to get a list of helpers available in your area.
"Open enrollment" is the period of time, once a year, when you can choose or change your insurance provider or what kind of plan options you want -- for example, monthly premium and annual deductible amounts -- for the upcoming calendar year.
For 2017 health care plans, the open enrollment period will run from November 1, 2106 to January 31, 2017.
Choose carefully, because after you make your choices, you must usually live with them until the next open enrollment period.
"Special enrollment" is an exception to the usual enrollment rules. If you qualify for special enrollment, you can sign up during a time period outside of the open enrollment period. The circumstances under which you may qualify for special enrollment include:
You should purchase a plan from the marketplace in the state you consider your primary residence -- where you vote, pay taxes, and so on. But snowbirds need to be sure they choose an appropriate “multistate” plan.
Some multistate plans may be restricted to a certain region – for example, a metropolitan area that straddles state boundaries. Others will be more appropriate for someone who migrates longer distances, spending, say, summers in Alaska and winters in Arizona.
Ask the insurance provider for details, and don’t sign up for a plan until you’re sure it will cover you where and when you need it.
What if I travel frequently?
Traveling shouldn't present any problem under a marketplace insurance plan. Simply sign up for a plan in the state of your primary residence. The plan will cover you in case of emergencies that happen out of state.
For more information about Obamacare in any state, including a link to the state’s health insurance exchange, choose the state from this list.
Information & Documents to Have on Hand
Here's a checklist of information to gather before you apply for health coverage at HealthCare.gov.
Social Security numbers for you and other members of your household who will be covered by your insurance plan
Policy numbers for any current health insurance plans
Documents to help you calculate your annual income. Include all sources, such as employment, pensions, alimony, rental property, or other income. If you have a job, gather together pay stubs or W-2 forms. If you’re self-employed, have last year’s tax return handy, as well other records that can help you estimate your yearly income.
If you or anyone in your household is eligible for job-based health insurance, a completed Employer Coverage Tool for each available plan
A good idea of your budget for health insurance, so you know how much you can afford to spend each month. This will help you choose the best plan from among those offered to you.
HealthCare.gov offers an Application Checklist you can print to help you keep track of everything you'll need to sign up.
Finally, keep a list of any questions you want answered before you sign up for a health insurance plan. To get answers to your questions, or for information on signing up for a plan, see How Do I Sign Up for Obamacare in New Jersey?
Press Release: New Website Provides Local Obamacare Information
September 23, 2013
A new website, ObamacareByZipCode.com, gives people the answers they need about the Affordable Care Act (Obamacare). In plain English, it guides consumers to reliable, local information about their new health insurance options.
When users choose their state or enter their zip code, they will quickly find:
whether or not they’re required to get health insurance
what the available plans cover
how much coverage will cost, and
how to sign up in each state.
For consumers concerned about cost, the site shows how to determine whether they qualify for subsidies. It also explains the new rules about expanded Medicaid eligibility.
The new site was created by Albin Renauer, founder of LegalConsumer.com, and is coauthored by Renauer and legal editor and writer Shae Irving. LegalConsumer, which until now has concentrated on consumer bankruptcy, began in 2005, when Congress overhauled federal bankruptcy laws.
“When politicians tried to make it harder to file bankruptcy, I vowed to make it easier. When I read about politicians making it hard to get information about Obamacare, it got my blood boiling -- and I realized I could help folks find that information the same way I do with bankruptcy.”
Some states, says Renauer, are hiding the ball when it comes to the new options for healthcare coverage under Obamacare. Missouri, for example, has not created an insurance marketplace (exchange), forbids state officials from cooperating with the federal government, and provides no information. “It is being run like a covert operation, with no marketing or detailed information about its products or their prices,” wrote the New York Times. (Missouri Citizens Face Obstacles to Coverage, Aug. 2, 2013.)
On ObamacareByZipCode.com, all consumers need to do, says Renauer, is start with a zip code. The site will guide them to all the official local resources they need to make sure they get the maximum benefits under the law.
Another reason for expanding a bankruptcy website to cover health care reform? It’s obvious to Renauer: “Huge medical bills are a major reason that people are forced into bankruptcy.”
LegalConsumer.com has helped more than a million consumers navigate the bankruptcy process by providing a free online “means test calculator,” which shows people whether or not they’re eligible to file for bankruptcy.
After receiving his J.D. from the University of Michigan Law School in 1985, Albin Renauer worked for various public-interest law firms in the Bay Area and as a staff attorney for Chief Justice Rose Bird of the California Supreme Court. He spent 17 years as an editor at leading do-it-yourself legal publisher Nolo, where he helped create numerous books and software programs, including the bestselling Quicken WillMaker. He also edited Law on the Net, the first online directory of legal resources, and was the architect of Nolo's Webby Award winning website.