Get answers to questions we commonly hear about insurance coverage and the open enrollment period. If you have a question we haven’t answered here, submit it to us.

While there’s generally just one time each year when anyone can purchase insurance –– that’s the open enrollment period happening now – “special enrollment periods” may be available for those who qualify. Significant life changes such as marriage, birth or adoption of a child, or loss of a job, as well as the ending of COBRA coverage, can lead to an opportunity to qualify for a special enrollment period.

Usually, these special enrollment periods have a 60-day window to purchase insurance through the online marketplace that starts when you experience the life change. However, in certain circumstances such as marriage or residency changes there are requirements to have previously had coverage.

To learn more about special enrollment periods click here.
This is the designated time each year when people can enroll in health insurance plans under the Affordable Care Act – either new consumers or those with existing coverage who want to change their plan. The Open Enrollment Period in New Jersey runs from Nov. 1, 2023, to Jan. 31, 2024, for health insurance coverage for 2024. The only other opportunity to enroll throughout the year is if you experience a major life event, like loss of a job, or if you qualify for the state’s NJ FamilyCare program.
NJ FamilyCare, which is the state’s publicly funded health insurance program, is available for eligible New Jersey residents year-round. You can apply at GetCoveredNJ.com – and we also can help you with that.

If you enroll by December 31, your coverage will start January 1. If you enroll in January, your coverage will start February 1.

The official site to shop for insurance plans and enroll is GetCoveredNJ. It provides a full lineup of the various plans available in New Jersey, their premiums and coverage levels and information about applying for financial help. You can shop, buy and apply for financial help directly from the site.

You also can start the process by working with an enrollment navigator, including the veteran navigators here. Our navigators have helped New Jersey residents sign up for insurance coverage since the very first open enrollment period in 2013. It’s free, and we have strict measures to protect your privacy and ensure the security of your personal information. Check the calendar or contact us for more information on working with our veteran navigators.
Whether you go to GetCoveredNJ or meet with one of our veteran navigators, you will need the following information for yourself and anyone in your household applying for coverage:

  • Home and/or mailing addresses
  • Birth dates
  • Social Security numbers
  • Document information for legal immigrants, if applicable
  • Employer and income information for every member of your household (for example, pay stubs or W-2 forms)
  • Your best estimate of what your household income will be in 2024
  • Policy numbers for any current health plans covering members of your household.
Plans and prices change every year, so it’s important to shop the various plans and compare. The GetCoveredNJ website provides that information, and we can also assist you with that.

Plans in the online marketplace are categorized with “metal” descriptions: Bronze, Silver, Gold and Platinum. These categories are based on how much of the costs your plan will cover and how much you will pay out of pocket. There are also “Catastrophic” health plans that cover only the most serious illnesses or injuries. Here are the category descriptions:

  • Bronze: The health plan pays 60 percent of total health care costs, and you pay about 40 percent. Bronze plans have the lowest premiums, but they also have the highest level of costs to the customer for things like deductibles and co-pays.
  • Silver: The health plan pays 70 percent of total health care costs, and you pay about 30 percent. People who qualify for premium tax credits may also qualify for more savings through cost-sharing reductions. These can only be applied to Silver plans.
  • Gold: The health plan pays 80 percent of total health care costs, and you pay about 20 percent. Gold plans have higher premiums and lower cost-sharing levels.
  • Platinum: The health plan pays 90 percent of total health care costs, and you pay about 10 percent. There currently are no Platinum plans available in New Jersey’s online marketplace.
  • Catastrophic: Available to individuals under the age of 30 and those who qualify for a hardship exemption. This plan has a low monthly premium, but a very high deductible. This may be an affordable way to protect yourself from costs of a serious illness or injury, but you pay most routine medical expenses yourself.
It’s possible you may qualify for financial help to lower the cost of your plan. According to the GetCoveredNJ website, there are three types of financial assistance: premium tax credits, cost-sharing reductions and NJ Health Plan Savings, a new state subsidy offered by the state of New Jersey. Premium tax credits and the state subsidy help lower your monthly premium payments. Cost-sharing reductions help lower your out-of-pocket costs like deductibles and co-pays for doctor visits.

In New Jersey, a family of four earning up to about $180,000 a year and an individual earning up to about $87,480 a year can qualify for financial assistance. Nine out of 10 enrollees are eligible for financial help to make insurance more affordable.

Visit Get Covered NJ’s Financial Help page for more information. It’s also important to note that the Get Covered NJ site is the place to also apply for coverage for NJ FamilyCare, which is a state program for healthcare coverage based on income.
You can go to GetCoveredNJ or enroll with one of our veteran navigators if you:

  • Live in the United States and have a primary residence in New Jersey
  • Are considered a resident of the United States and New Jersey for tax purposes
  • Are a U.S. citizen or national. If you are a non-citizen, you must be lawfully present in the U.S. for the entire time you plan to have health coverage
  • Are not currently incarcerated.

Individuals who are not eligible to buy health insurance through GetCoveredNJ can still apply for other members of their household who are eligible. For example, parents who are not lawfully present in the state can still enroll their children in health insurance through GetCoveredNJ if their children are eligible.
Yes. The State of New Jersey has a requirement for New Jersey residents to have health coverage or make a “shared responsibility payment” during tax time, unless you qualify for an exemption. State officials note that making sure all residents have health coverage helps make sure there are more health plans available for consumers to choose from. Health insurance is also an important part of having access to the healthcare services you need to support your own good health.
Yes. The state Department of Banking and Insurance and the federal Affordable Care Act require all of these plans to provide certain “essential health benefits.” These benefits include:

  • Ambulatory care (outpatient) services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services, including annual physicals and mammograms
  • Chronic disease management
  • Pediatric services

In addition, the requirements state that some routine and preventive care, like certain vaccinations and well child visits, must be provided free under these plans.
A pre-existing condition will not keep you from getting health coverage. An insurance company can’t turn you down or charge you more because of your condition.

It depends. Each insurance company has a network of doctors in each plan. Plans do not provide coverage for doctors who are not in their network. The GetCoveredNJ site provides information about the plans individual doctors participate in.
The Affordable Care Act allows children to be added to or kept on a parent's health insurance policy until they turn 26 years old. Children can join or stay on a parent's plan even if they are:

  • Married
  • Not living with their parents
  • Attending school
  • Not financially dependent on their parents
  • Eligible to enroll in their employer’s plan.

If you buy an individual plan and your adult children under age 26 are your dependents for tax purposes, you can add them to your plan. The same is true if the adult children are not dependents and you are not applying for assistance to pay for your coverage.