Don’t have health insurance for 2021? Open enrollment begins with new NJ marketplace

New Jersey’s new government-run health insurance marketplace is now open for business, and it is

New Jersey’s new government-run health insurance marketplace is now open for business, and it is expected to provide coverage next year to hundreds of thousands of New Jerseyans who buy plans on their own.

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a man and a woman sitting in a chair: Ishmeal Alarbi, is shown at the Hackensack Meridian Health's COVID Recovery Center with Certified Medical Assistant, Sharlene O'Blenis, during a follow-up visit. The center was created in July for patients with persistent symptoms of COVID-19. Tuesday, August 25, 2020


© Kevin R. Wexler/NorthJersey.com
Ishmeal Alarbi, is shown at the Hackensack Meridian Health’s COVID Recovery Center with Certified Medical Assistant, Sharlene O’Blenis, during a follow-up visit. The center was created in July for patients with persistent symptoms of COVID-19. Tuesday, August 25, 2020

Here is how Get Covered New Jersey works: 

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Who participates?

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New Jersey’s new marketplace is primarily for residents who do not get coverage through an employer and are not eligible for Medicare.

Residents can shop for coverage and enroll if they do not have insurance yet for 2021 or have coverage via the federal Healthcare.gov and want to change their plans.

How do I sign up?

The new website is getcovered.nj.gov. 

Residents enrolled in a health plan through Healthcare.gov will be automatically transitioned to Get Covered New Jersey.

If you qualify for Medicaid, the website will direct you to NJ FamilyCare after you input income and household information. 

When can I sign up?

Open enrollment began Sunday and will end Jan. 31.

The three-month enrollment period is double the window of time used by Healthcare.gov.

There are also special enrollment periods and triggering events like pregnancy.

“There’s a flexibility around this that we just have not had before,” Gov. Phil Murphy said last week.

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When does coverage begin?

Policies kick in on the first day of the month after purchase. 

Coverage can begin as early as Dec. 1 if a policy is purchased in November.

What if I have a preexisting condition?

You cannot be denied coverage if you have preexisting conditions. 

Insurers are banned from using factors other than age to determine premiums. 

What’s the minimum amount of coverage? 

All plans must cover the 10 essential benefits required under the Affordable Care Act: 

  • Outpatient care such as visits to a doctor’s office, clinic or surgery center.
  • Emergency services.
  • Hospitalization including for surgery.
  • Pregnancy, maternity and newborn care. 
  • Pediatric services, including oral and vision care. 
  • Mental health, substance abuse services and behavioral treatment, including counseling and psychotherapy.
  • Prescription drugs.
  • Lab services.
  • Rehabilitative services and devices.
  • Preventive and wellness services and chronic disease management.

What insurers are participating? 

  • Horizon Blue Cross Blue Shield of New Jersey.
  • AmeriHealth New Jersey.
  • Oscar Health Insurance.
  • Oxford Health.

As in previous years, different levels of coverage — bronze, silver and gold — are available. 

Am I eligible for financial assistance?

Consumers must have incomes below $51,040 for an individual or $104,800 for a family of four to qualify.

What’s the average premium going to cost me?

When federal tax credits and new state subsidies are included, the average premium for 2021 will drop to $117 monthly, according to the Murphy administration.

Officials say it’s the lowest in years, compared with $164 monthly last year and $148 monthly in 2014.

Without subsidies, the average rate hike was 3.3%. That includes increases of 10.4% for Oxford, 6.5% for AmeriHealth, 6.1% for Oscar, and 1.1% for Horizon.

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What if I don’t sign up?

All state residents, with limited exceptions, are required to have health coverage or pay a penalty. 

In 2019, the minimum tax penalty was about $700 and the maximum was $3,000 for an indvidual individual. 

How big is the need?

About 218,000 New Jerseyans have received their coverage via the Affordable Care Act. 

That may grow. 

Due to the COVID-19 pandemic and economic downturn, there were 131,000 more New Jerseyans unemployed in September than in September 2019, according to the latest federal labor data.   

“No one knew we would be in the midst of a pandemic when this launched, but what everyone has seen and learned this past year is that we all are vulnerable and need health care,” said Maura Collinsgru, health care program director with New Jersey Citizen Action, an advocacy group.

Scott Fallon covers the environment for NorthJersey.com. To get unlimited access to the latest news about how New Jersey’s environment affects your health and well-being,  please subscribe or activate your digital account today.

Email: [email protected] 

Twitter: @newsfallon 

This article originally appeared on NorthJersey.com: Don’t have health insurance for 2021? Open enrollment begins with new NJ marketplace

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