Understanding your Health Insurance Options
Passage of the Affordable Care Act (ACA) put in place comprehensive health insurance reforms that will roll out over a series of years. Some of these reforms are focused on health insurance companies and mandates for coverage, many of which have already been implemented. Another component of the ACA requires that Americans purchase health insurance coverage.
Open Enrollment Period Begins November 1
Open enrollment for the upcoming insurance year (January 1 - December 31, 2019) begins on November 1, 2018, and ends on December 15, 2018.
For coverage to start on January 1, subscribers have to apply by December 15. Insurance coverage is mandatory for most citizens and those who do not qualify for an exemption from this law may be required to pay a fee when they submit their tax return. Details about this fee and special exemptions from it can be found here.
Possible Cost Savings for You
One of the things that people express concern about when the subject of health insurance comes up, is the cost. Some relief may be in sight.
Depending upon your income, you may be eligible to receive a Premium Tax Credit, which you can use now to reduce the cost of your insurance monthly premium or receive later when you file your taxes at the end of the year.
Cost-Sharing Reductions will lower your payment on deductibles, copays, and coinsurance. This is available to those who meet all of the following criteria: 1) income guidelines; 2) are eligible for the Premium Tax Credit; and, 3) are enrolled in a Silver plan. See if you qualify.
Renewing Your Coverage
If you received health insurance coverage through the Marketplace last year your policy, or similar coverage, may be automatically renewed for the coming year or you may receive a notification explaining that you can't receive an automatic renewal. You also have the option of changing your plan. Learn more about your options here.
Enrollment during any other time of year is only permitted under the following circumstances:
- If you are eligible for Medicaid or CHIP (Children's Health Insurance Programs) you can enroll at any time of year, but within 60 days of the time, you became eligible.
- If you are eligible to participate in a special enrollment period you can apply at a time that is outside of the open enrollment period, but within 60 days of the time, you became eligible. To qualify for the special enrollment you must have had a qualifying life event (like getting married, having a baby, moving to a new area, or losing other health coverage) or have had a complex situation related to applying for coverage.
Get Help with Enrollment
If you are looking for someone who will personally walk you through the enrollment process consider the following resources.
- Navigators and their assistants - These professionals have completed a comprehensive training and will help consumers prepare applications to establish eligibility and enroll in coverage through the Marketplace. They will also run community programs to raise awareness and will refer consumers that have complaints to health insurance ombudsmen. Those eligible for NJ Family Care or Medicaid will be given assistance as well. To find a Navigator search our resource database at the top of this page using the search term Navigator Programs.*
- Certified Application Counselors - Counselors have undergone ACA training as well but often work for an agency that is engaged in other support services or within the healthcare industry. Their services are usually free of charge but not always. To find a Certified Application Counselor search our resource database at the top of this page using the search term Certified Application Counselor Programs.*
- Agents and Brokers - Licensed agents and brokers may assist in the application process as well. These professionals can assist consumers in the Marketplace but must first complete a two-part registration process. Agents and brokers are compensated by health insurance issuers for assisting consumers.
- You can also search the Marketplace database for navigators and counselors who will provide help to you.
Local Enrollment Events Providing FREE Assistance
CoverNJ is a collaborative project of Affordable Care Act Outreach and Enrollment Groups across the state, working to connect more New Jerseyans to health insurance options now available under the ACA. At CoverNJ you will find a listing of enrollment locations. Local events that we have been notified of are listed below.
Help Available in the Counties of HUNTERDON, MERCER, MORRIS, OCEAN, and SOMERSET
The Family Resource Network Health Insurance Navigator Program provides trained navigators to assist people in obtaining health insurance if you are a resident of the counties noted above. Trained navigators can help you understand your healthcare options and assist in completing the application. Call 800.355.0271 for further information and check for local events here.
Learn More at these Sites
Healthcare.gov This site is the Health Insurance Marketplace. It has all of the online tools used to apply for health insurance. You'll find answers to frequently asked questions, educational pages devoted to target audiences and access to all of the contact information you need to get questions answered.
Health Insurance Explained - The YouToons Have it Covered
This cartoon video is the third YouToons video produced by the Kaiser Family Foundation. It explains health insurance concepts, such as premiums, deductibles, and provider networks, in a light-hearted way and also talks about how individuals pay for coverage, how prescription coverage works and the variety of healthcare coverage that is available.
Get Covered America Provides a guide to understanding the basics of health insurance, and your new health insurance options through the Health Insurance Marketplace. This site is also available in Spanish.
Health Insurance Help Guide for College Students This guide is designed to help make health insurance less confusing for students by providing information on the types of coverage that is available, how to choose and sign up for insurance, and what to do about health care when studying overseas.
The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many reforms of the Affordable Care Act. CCIIO oversees the implementation of the provisions related to private health insurance. In particular, CCIIO is working with states to establish new Health Insurance Marketplaces. CCIIO works closely with state regulators, consumers, and other stakeholders to ensure the Affordable Care Act best serves the American people.
* Only those Counselors and Navigators who provide their services free-of-charge are included in our database.