How do I sign up for a health plan through GetCoveredNJ? | Mira Health
How do I sign up for a health plan through GetCoveredNJ?
The New Jersey open enrollment period (OEP) for 2023 coverage starts November 1st, 2022, and ends January 31st, 2023. You will make an account, shop for plans, then select the health plan that's best for you. Finally, you can enroll.
The Affordable Care Act, also known as Obamacare, was a piece of legislation designed to make healthcare costs more affordable. Understanding how to properly sign up for this type of health coverage is essential. The following article will detail how to sign up for an ACA plan as a self-employed individual living in New Jersey. Aspects such as income, household size, and employment must all be appropriately considered while making this decision.
How Do I Sign Up for an ACA Plan in New Jersey as a Self-Employed Individual?
Signing up for an ACA Plan in New Jersey can be tricky. New Jersey uses their own official Healthcare Marketplace portal for insurance enrollment. This website will be where you select, apply, and enroll in an ACA health plan.
When is the open enrollment period for New Jersey?
Health insurance enrollment must occur within a specific period. The New Jersey open enrollment period (OEP) for 2023 coverage starts November 1st, 2022, and ends January 31st, 2023. If you find that you have missed NJ’s OEP, there is a possibility that you might qualify for a special enrollment period (SEP) so that you may still have coverage for the year.
Certain life events may qualify you for SEP. These include:
- Losing your current health insurance plan due to: job loss, growing out of your parent’s insurance, or divorce
- Losing eligibility for Medicare, Medicaid, or CHIP
- Life events such as pregnancy, adoption, or having a baby
New Jersey also provides a free/low-cost program for uninsured individuals called NJ FamilyCare. This program is New Jersey’s Medicaid program; it allows for year-round enrollment and helps any qualifying New Jersey residents, regardless of age, sign up for affordable health coverage. Eligibility for NJ FamilyCare is based on household income and the size of your household. Find out more about how to apply with this website.
Step 1: Make an account and start an application
Before making an account, GetCoveredNJ provides an estimation tool for how much financial help you might receive based on your income, household size, and location. After this estimate, GetCoveredNJ will provide you with various plan options to browse through. However, to enroll, you will need to create an application. Using this link, you can input certain basic information to submit your application.
If you believe you qualify for the special enrollment period, submit the appropriate “qualifying life event” and date in your application. After you submit your application, you will be able to see whether or not you are eligible for the SEP.
To sign up efficiently, make sure that you have the following information available and prepared:
- Basic identification information: name, birthday, social security number, household address, and mailing address
- Household information: your household size, your household income, your spouse’s income, how many dependents you have
Step 2: Shop for plans
Before applying to a health insurance plan, it is highly recommended that you understand the different plan options. You can preview price estimates based on household size, income, and preferences. New Jersey’s ACA health exchange website offers a personalized “Shop and Compare” tool. It will show you what potential savings you might qualify for and recommend different plans based on your responses.
The following are the basic categories of plans that you will have the option of selecting. These plans vary based on monthly premiums and are suited to various living situations. It is highly recommended to consider your own health needs and financial situation carefully. The chart below outlines the best plans based on health coverage needs and income.
ACA Plan Options for A Self-Employed Individual Living in New Jersey
| ACA Plan | Monthly Premium | Insurance Pays | You Pay (Deductible) | Plan Features |
|---|---|---|---|---|
| Bronze | $ | 60% | 40% | A good option for young and healthy individuals. |
| Silver | $$ | 70% | 30% | A good option for healthy, low-income individuals. |
| Gold | $$$ | 80% | 10% | Best for people who need comprehensive coverage |
| Platinum | $$$$ | 90% | 10% | Best for people with frequent medical needs |
These different tiers of plans can be categorized into 4 different plan types. These categories tell you how flexible your healthcare network is and whether you will have access to specialists. These plans types include:
- Health Maintenance Organizations (HMO)
- Exclusive Provider Organization (EPO)
- Preferred provider organizations (PPO)
- Point of Service Plans (POS)
Most ACA plans tend to be either HMOs or PPOs. The differences between each type of plan are outlined in the chart below:
| Type of Plan | Network flexibility? | Cost? | Primary care physician? | Referrals for specialists? |
|---|---|---|---|---|
| HMOs | Must stay in-network, except for emergencies | $ | Required | Yes |
| EPOs | Must stay in-network, except for emergencies | $$ | Required | No |
| PPOs | Out-of-network options are available but more costly | $$$$ | Not required | No |
| POS | Out-of-network options are available but more costly | $$$ | Required | Yes |
Step 3: Select a Health Plan and Enroll
For a single self-employed individual, the GetCoveredNJ website will provide you with a list of personalized options with different price points. These options will be based on how often you need medical attention, how many prescriptions you have, and your income. You can filter by the plan types mentioned above. You can compare and contrast different options to choose your best possible plan.
Once you have selected a health plan, all you have to do is enroll. To enroll correctly, you must pay your plan's first monthly premium on time. Once that premium is paid, your coverage will start.
Ways to Make Insurance More Affordable in New Jersey
New Jersey, specifically, has a program that can help lower-income individuals afford their health insurance. This program is a new piece of legislation called New Jersey Health Savings (NJHPS). NJHPS can help eligible families reduce their monthly premium cost with a state-provided subsidy. Find out if you are eligible on GetCoveredNJ.gov.
Several federal government programs can help to make your insurance more affordable. For instance, you might qualify to have:
- Premium Tax Credit (PTC): This refundable tax credit can lower your health insurance premium. Eligibility is based on income, so mainly low-moderate will be able to receive a PTC.
- Cost-Sharing Reduction (CSR): This is a government-provided discount to help reduce out-of-pocket costs for low-moderate income families and individuals. CSRs will help to decrease your deductible, co-pay, or co-insurance fees.
Or, you might be qualified for any federally funded insurance programs:
- Medicaid: insurance program for low-income individuals under the age of 65.
- Medicare: insurance program for people 65 and older, people with disabilities, or people with end-stage kidney disease requiring dialysis or transplant.
- Children’s Health Insurance Program (CHIP): for uninsured children under the age of 19
- Veterans Health Administration (VHA): medical services for American Veterans who have served for 24 uninterrupted months.
- TRICARE: insurance program for military families
ACA Health Coverage Frequently Asked Questions (FAQs)
The following FAQ section will answer any frequently asked questions about the ACA Healthcare Marketplace.
What benefits are provided by ACA?
Any plan that is in the ACA exchange is required to meet minimum essential coverage (MEC). There are 10 categories of service that fall under the MEC. These 10 benefits include:
- Outpatient care
- Emergency care
- Inpatient care/hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use services
- Prescription drugs
- Rehabilitation services and devices
- Laboratory services
- Preventive care and chronic disease services
- Pediatric care
How much does each tier plan cost in New Jersey?
Although these costs might vary based on what company/plan you choose, the following are the average premium costs for each metal tier in 2022:
- Bronze: $349
- Silver: $400
- Gold: $610
Can an outside party help me enroll in ACA health plans?
Yes, you can contact several professionals to help you properly enroll in any ACA health plan. GetCoveredNJ has several resources and contact information of individuals you can reach out to, including assisters, agents, and brokers. You can search for local assistance based on your location with the filter provided on the portal.
Bottom Line
Overall, applying for and enrolling in ACA plans can be difficult. However, it is fundamental to understand how to apply to ACA health plans properly, especially for self-employed individuals or individuals without an employer insurance plan. New Jersey is one of the states that utilizes its ACA exchange health portal. This portal will guide you through enrollment and help you find your most suitable plan.