Get Covered New Jersey offers financialhelp to qualifying residents to help lower their monthly premiums and out-of-pocket expenses. Due to the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, Get Covered New Jersey customers are eligible for expanded financial help for all income levels. The State of New Jersey is also providing additional savings. This means more peoplequalify for more financial help.
If youbuy a plan on the Marketplace, you may qualify for:
- Premium Tax Credits
- Cost-sharing reductions
- New Jersey Health Plan Savings
Eligibility for financial help is based on income, household size, and a few other factors.
You should use the GetCoveredNJ Shop and Compare Tool to see what your premiums might be.
Premium tax credits helplower your monthly premium payments. Eligibility for the premium tax credit is based on several things including income and household size.
Under the American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022, more people now qualify for more financial help. Previously, premium tax credits were only available up to certain income levels ($51,040 for an individual or $104,800 for a family of four). Effective in 2021, there are no longer income limits for consumers to qualify for financial help through Get Covered New Jersey.
Your premium tax credit amount is based on a sliding scale. Those with a lower income get a larger credit to help cover the cost of their insurance. Premium tax credits will apply at every income level to ensure that no household pays more than 8.5% of income for a benchmark plan purchased through the Marketplace. A benchmark plan is the second-lowest cost Silver plan in a consumer’s area that is used to calculate federal premium tax credits. Some households will qualify for nearly free coverage.
You can apply some or all of your premium tax credit to your monthly insurance premium payment. The Marketplace will send your tax credit directly to your insurance company. You will pay less each month. This is called taking an “advance payment of the premium tax credit” or APTC.
If you use advance payment of the premium tax credit to lower your monthly premium payment, you will have to “reconcile” those tax credits when you file your federal income taxes the following year using IRS Form 8962.
This means you will compare:
- the amount of premium tax credit you used during the tax year to lower premiums and
- the amount of premium tax credit you qualify for based on your final annual income for that year on your tax return.
The difference between these two numbers is what you may owe in your taxes if your income was higher than what you put on your application, or what you may be refunded if your income is lower than what you put on your application. You will get a 1095-A form from Get Covered New Jersey by January 31st so you can fill out federal tax Form 8962.
Remember:
Changes in income or household size may lower or raise your premium tax credit. Your advance premium tax credit amount is based on the income you think you are going to make in the coming year. It changes based on how many people are in your tax household (you, your spouse and your tax dependents). When you file your taxes, you will need to report the amount of premium tax credit you used. If your income or household size changes during the year, you may owe back part of the premium tax credit. Or you may get more premium tax credit.
If your income or tax household size during the year is not what you put on your application, it is important to update your application on GetCoveredNJ right away. This is to make sure your premium tax credit is correct. Consumers are required to report changes in income and tax household size within 30 days to GetCoveredNJ.
If your income goes up or you lose a tax household member, you will probably qualify for less premium tax credit. If you think your income might go up or your tax household size may go down, you can lower the tax credit amount you take in advance each month. You can do this at the end of the GetCoveredNJ enrollment process. This will help make sure you do not owe back any of the tax credits you took in advance for health premiums.
If your income goes down or you gain a tax household member,you will probably qualify for more premium tax credit. If you have these changes, update your application to find out if your premium tax credit goes up.
If at the end of the year you have taken more advance payments of the premium tax credit (APTC) than you qualify for, you may have to pay money back when you file your federal income tax return. This is called “reconciling” your APTC with the actual premium tax credit you qualify for based on your final annual income.
Cost-Sharing Reductions (CSRs)
People who qualify for a premium tax credit and have household incomes between 138% and250% of the federal poverty level also qualify for CSRs. This is a discount that lowers the amount you pay for out-of-pocket costs such as deductibles, co-pays, and co-insurance. It means you pay less out-of-pocket each time you get medical care, including at the doctor’s office, hospital, or urgent care.
In the Marketplace, CSRs are often called “extra savings.” If you qualify for these extra savings, you get them only if you enroll in a health plan at the Silver level. When you shop for plans, look for the plan level: Bronze, Silver or Gold. You can use a premium tax credit for a plan at any level, butyou will only get the extra CSRs if you choose a Silver plan. More information on plan levels is here.
If you qualify for CSRs, you also have a lower out-of-pocket maximum. Every time you pay out-of-pocket at the doctor’s office or for prescription drugs, those payments go towards your maximum. When you reach your maximum, your plan covers 100% of all covered services.
If you are a member of a federally recognized tribe or are an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may qualify for more CSRs.
New Jersey Health Plan Savings
Since 2021, New Jerseyans have had access to a state subsidy – called New Jersey Health Plan Savings (NJHPS) – that lowers the cost of health insurance.
New Jersey residents qualify for these savings based on income. New Jersey Health Plan Savings are available to eligible households with annual incomes up to 600% of the federal poverty level. In 2024, an individual with an income of up to $87,480 and a family of four who makes up to $180,000 can receive state subsidies to lower the costs of health coverage. Anyone who qualifies will be able to see a lower premium using our plan comparison tool or after filling out an application.
Learn more about New Jersey Health Plan Savings.
Medicaid program: If your income is at or below 138% of the federal poverty level ($1,677/month or $2,267 for a family of two), then your Marketplace application may find that you likely qualify for NJ FamilyCare, a publicly funded health insurance program with free or low cost coverage. Consumers eligible for NJ FamilyCare cannot get financial help with their coverage through GetCoveredNJ.
CHIP (Children’s Health Insurance Program): If your income is at or below 355% of the federal poverty level ($8,875/month for a family of four), then your Marketplace application may find that your children likely qualify for NJ FamilyCare, a publicly funded health insurance program for children with free or low cost coverage. Children eligible for NJ FamilyCare cannot get financial help with their coverage through GetCoveredNJ.
