Get Financial Help
Get Covered New Jersey offers financial help to qualifying residents to help lower their monthly premiums and out-of-pocket expenses. Due to the American Rescue Plan Act, Get Covered New Jersey customers are now eligible for expanded financial help for all income levels. The State of New Jersey is also providing additional savings. This means more people qualify for more financial help.
If you buy a plan on the Marketplace, you may qualify for:
- Premium Tax Credits *New and expanded in April 2021
- Cost-sharing reductions
- New Jersey Health Plan Savings *New and expanded in April 2021
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
Under the new American Rescue Plan Act changes, 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 May 1, 2021 through 2022, 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 (the second-lowest cost Silver plan in a consumer’s area that is used to calculate federal premiums tax credits) purchased through the Marketplace. 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” 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.
Cost-Sharing Reductions (CSRs)
People who qualify for a premium tax credit and have household incomes between 138% and 250% 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, but you 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 CSR.
New Jersey Health Plan Savings
New Jersey residents will qualify for these new savings based on income. Households with annual incomes up to 600% of the FPL will receive the new and expanded NJHPS. In 2022, an individual with an income of up to $77,280 and a family of four who makes up to $159,000 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 ($3,048/month for a family of four), 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 ($7,914/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.