Getting Health Insurance

There are different ways you can get health insurance or coverage.

  • If you're under the age of 26, for example, you may want to explore whether you can stay on a parent's plan.
  • You may qualify for coverage through a job, or maybe a student health plan.
  • Some people might want to use the New Jersey Health Insurance Marketplace, which is called Get Covered NJ, to check out options – that's a way to figure out whether you qualify for tax credits to buy a plan or NJ FamilyCare (Medicaid and/or CHIP).

Here are a few things to consider when figuring out your insurance options and understanding your plan:

1. To check for coverage, it is important to have these key pieces of information:

  • Estimated annual income
  • Home and mailing addresses
  • Birth dates(s) and Social Security numbers of anyone in your household who needs coverage
  • Documentation for lawfully present immigrants and non-citizens (if applicable)

2. Make sure you understand the difference between premiums, co-pays, co-insurance, and deductibles. Often, plans get picked based on the monthly premium, but the co-pays, co-insurance, and deductibles can add up when you get care. So, you'll want to look at and know those details. In some cases, you might decide to pay more in premiums for different levels of coverage. This is a personal decision and depends on your resources, your assessment of your health needs and your tolerance for risk.

  • Example: Let's say you get an infection that requires a trip to the ER. Between the care, the multiple tests and imaging, the bill comes out to $12000 total.
  • Plan 1. You pay $250 a month in premium, but you have a $5000 deductible and a 20% coinsurance on an ER visit. Let's assume you hadn't paid anything towards your deductible already. Your portion of that ER trip would be $5000 towards the deductible, plus 20% (your coinsurance) of the remaining $7000 which is $1400. The cost of the ER visit to you would be $6400.
  • Plan 2. Now let's do the same scenario but with a plan where you pay $560 in monthly premiums with no deductible and no coinsurance, but with an ER visit co-pay of $500. You would be responsible for the co-pay, the $500.

3 .Understand which services are covered under your plan, and which are not. For example, most health plans do not include dental or prescription eyeglass appointments. (Look further down on this page for more resources related to Mental Health including Substance Abuse, Prescription Drugs, Dental Care or Eyeglasses.

Resources

Get Covered NJ. This is the New Jersey Health Insurance Marketplace. Entering your details through Get Covered NJ will let you know if you qualify for tax credits or NJ FamilyCare (Medicaid/CHIP). Here's their FAQ with detailed answers on applying, officially enrolling in a plan, and other key information. FYI, you can generally get coverage this way if you are eligible for NJ Family Care, if it's during an annual open enrollment period, or if you have a major life event (like moving to New Jersey, turning 26 and losing coverage through a parent's plan, or a pregnancy). For more information, you can call the Customer Service Center at 1-833-677-1010. You may also want to get local help by talking to an assister or an agent / broker.

Free Health Care Enrollment Assistance offered by New Jersey Citizen Action. One-on-one enrollment assistance to apply for healthcare through New Jersey's marketplace, GetCoveredNJ and NJ FamilyCare. Healthcare education workshops in English, Spanish, and Hindi are also offered. Call 1-888-654-3893 or email getcovered@njcitizenaction.org. There are 3 locations by appointment only:

  • The Hahne's Building, 625 Broad Street, Suite 270, Newark, NJ 07102
  • 75 Raritan Avenue, Suite 200, Highland Park, NJ 08904
  • 1040 Kings Highway, Suite 308, Cherry Hill, NJ 08034