With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike.
Most New Jerseyans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges.
Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Florida, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in New Jersey
New Jersey ranked 11th in United Health Foundation’s 2014 America’s Health Rankings. Its strengths included a low rate of drug deaths, a low percentage of children in poverty, and ready availability of primary care physicians and dentists. Challenges for New Jersey included a high prevalence of physical inactivity, a high prevalence of low birthweight and a high rate of preventable hospitalizations.1
New Jersey individual and family health insurance
New Jersey is one of 5 states that has a “shared responsibility payment”. This is a tax penalty which applies if you do not have qualifying health insurance.
Those who buy ACA health insurance may be eligible for income-based subsidies – including premium tax credits that may be applied to any metal plan, and cost-sharing subsidies that apply to silver plans.
When the Obamacare health insurance exchanges opened for 2014 enrollment, New Jersey defaulted to the federal health insurance marketplace, healthcare.gov. Individuals and families living in New Jersey may purchase health insurance coverage through the state’s federally facilitated exchange and in the private marketplace.
The U.S. Department of Health and Human Services reported that 161,775 individuals in New Jersey selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in New Jersey enrolled in a marketplace plan increased to 254,316 during the open enrollment period.3
|New Jersey’s health insurance exchange:||healthcare.gov|
|New Jersey’s department of insurance:||state.nj.us/dobi|
New Jersey small group health insurance plans
In New Jersey, small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program, SHOP Marketplace, and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from healthcare.gov.
New Jersey state COBRA variations for small groups 4 5
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may qualify for health insurance continuation through mini-COBRA programs. State mini-COBRA programs allow those who work for a small business and lose health insurance coverage due to a qualifying event to continue coverage, too. These programs generally work like the federal COBRA continuation coverage, but their terms may vary. New Jersey’s small group COBRA continuation variations are as follows:6
|Mini-COBRA option||Yes, known as New Jersey Continuation|
|Eligible group sizes||2 to 50, unless subject to federal COBRA, which generally covers group health plans for employers with 20 or more employees|
|Maximum continuation period – standard||18 months for employees who have been terminated “other than for cause” or whose hours have been reduced to fewer than 25 per week | 36 months for a spouse or dependent child in the event of a divorce or the employee’s death, or when a dependent child ceases to be a dependent under the terms of the group health plan.|
|Maximum continuation period – disabled||29 months if determined disabled under the Social Security Act|
|Maximum premium increase||102 percent (entire premium cost plus administrative fees) Up to 150 percent for months 19 through 29 if disabled under the Social Security Act|
|State legislation reference||N.J.S.A. 17B:27A-27|
|More Information||609-292-1704 – compliance concerns|
|Additional notes||New Jersey law does not subject employees to a minimum coverage period before they are eligible for state continuation coverage.Employees have 30 days from a qualifying event to elect continuation coverage to the employer in writing.|
New Jersey high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.7
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPS and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
New Jersey elected to operate its own state-based PCIP program, NJ Protect, with federal funding and did not have a separate state high-risk pool.
New Jersey Medicaid
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 138 percent of the federal poverty level.
New Jersey decided to expand its Medicaid program in 2014.
The information below is specific to New Jersey’s Medicaid program, which is part of NJ FamilyCare:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||New Jersey Department of Human Services, Division of Medical Assistance & Health Services|
|Where to apply||healthcare.gov |njfamilycare.org/apply.aspx|
|Phone number||800-701-0710 (TTY 800-701-0720)|
|Eligibility||New Jersey resident, U.S. citizen or qualified non-citizen, Children, pregnant women, parents and caretakers, single adults and childless couples who meet financial eligibility requirements8|
|Open-enrollment period||Year-round in all states|
New Jersey CHIP
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines. The information below is specific to to New Jersey’s CHIP program.
|Program name||NJ Family Care/Medicaid|
|Where to apply||njfamilycare.org/apply.aspx | healthcare.gov|
|Phone number||800-701-0710 (TTY 800-701-0720)|
|Eligibility||Uninsured children 18 and under with household incomes up to 350 percent of the federal poverty level ($82,425 for a family of four)9; U.S. citizens or qualified non-citizens, residents of New Jersey|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. “Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment: For the Period: October 1, 2013–March 31, 2014 (Including Additional Special Enrollment Activity Reported through 4-19-14).” May 1, 2014. Retrieved fromhttp://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf.
6 DeRosa, EllenAdvisory Bulletin 07-SHE-02. . State of New Jersey Department of Banking and Insurance, Individual Health Coverage Program & Small Employer Health Benefits Program. June 20, 2007. Retrieved fromhttp://www.state.nj.us/dobi/division_insurance/ihcseh/bulletins/sehblt07_02.pdf.
7 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
8 State of New Jersey. “Who is Eligible?” NJFamilyCare.org. Retrieved from http://www.njfamilycare.org/who_eligbl.aspx.