At EIMA Health, we help residents of New Jersey get health coverage without the confusion. Whether you need an ACA Marketplace plan, Medicare for seniors and people with disabilities, or NJ FamilyCare and CHIP, we walk you through the process step-by-step. Book a free consultation: https://calendly.com/emily-eimahealthinsurance/get-expert-health-insurance-advice or call.
Call Today: (609) 422-9423
We are dedicated to simplifying the New Jersey health insurance process, guiding you through every step of your insurance journey to ensure you understand your options and secure the coverage that best fits your unique needs, whether you’re a senior, a growing family, an individual, or a business owner. you’re a senior, a growing family, an individual, or a business owner.
Navigating Healthcare in the Garden State: Medicare, Medicaid, and the ACA for New Jersey Families, Individuals, and Businesses
New Jersey, a densely populated and diverse state of over 9.3 million residents, boasts vibrant communities from the bustling metropolitan centers of Newark, Jersey City, Paterson, and Elizabeth to the suburban hubs of Edison and Woodbridge, and the iconic Jersey Shore region including Lakewood and Toms River. Across the Garden State, residents share a fundamental need for accessible and affordable healthcare. However, the intricate world of health insurance, encompassing Medicare, Medicaid, and the Affordable Care Act (ACA), can often seem complex and overwhelming.
How We Help
– ACA Marketplace enrollment (GetCoveredNJ)
– Medicare plan guidance for seniors and people with disabilities
– Medicaid and CHIP application support
– Special Enrollment Period assistance
New Jersey residents can shop ACA plans through:
GetCoveredNJ (https://www.getcovered.nj.gov). Medicaid is offered through NJ FamilyCare, providing
coverage for low-income individuals, families, seniors, and people with disabilities. CHIP
gives low-cost or free coverage to eligible children.
Understanding New Jersey’s Health Landscape: Key Statistics and Trends
New Jersey has seen consistent population growth, with a 2.3% increase – or over 211,000 new residents – since April 2020, reflecting its ongoing appeal as a place to live and work.
The state has also made significant strides in health coverage. In 2023, the uninsured rate for women of childbearing age in New Jersey was 9.0%, and for children under 19, it was 4.2%. While there are still gaps, New Jersey’s proactive approach to health coverage, including its own state-based marketplace and Medicaid expansion, has helped keep its uninsured rate lower than many other states. [Source: March of Dimes – PeriStats]
These statistics highlight the critical role that Medicare, Medicaid, and the ACA play in providing essential health coverage and a robust safety net for millions of New Jerseyans.
Medicare: Securing Your Golden Years in New Jersey
For New Jerseyans aged 65 and older, or those with certain disabilities, Medicare is the primary source of health coverage. As of 2025, more than half (54%) of eligible Medicare beneficiaries nationally are enrolled in Medicare Advantage plans, indicating a significant trend towards these comprehensive options. New Jersey residents also have a wide array of choices for Medicare coverage. [Source: KFF – Medicare Advantage in 2025]
How Medicare Benefits New Jersey Seniors:
- Financial Protection: Medicare substantially reduces the financial burden of healthcare costs in retirement, covering a significant portion of hospital stays, doctor visits, and preventive care.
- Access to Care: It ensures seniors have access to a vast network of healthcare providers across New Jersey and the U.S.
- Choice of Pathways: New Jersey seniors can choose between Original Medicare (often supplemented by Medigap and Part D) or a Medicare Advantage plan, tailoring coverage to their specific needs.
Medicare FAQs for New Jersey Residents:
What are the current costs for Original Medicare (Parts A & B) in New Jersey for 2025?
Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance).
Resource: For official Medicare information and current costs, visit Medicare.gov.
Part A covers inpatient hospital stays, skilled nursing facility care, and some home health care. Most New Jersey residents don’t pay a monthly premium for Part A if they or their spouse paid Medicare taxes for enough years. The Part A deductible for an inpatient hospital stay in 2025 is $1,676 per benefit period.
Part B covers doctor’s services, outpatient care, and preventive services. The standard Part B premium for 2025 is $185.00 per month, and the annual deductible is $257. After your deductible, you typically pay 20% of the Medicare-approved amount for most services.
Does New Jersey have a “Birthday Rule” for Medigap policies?
Yes, New Jersey has a unique “Birthday Rule” (often referred to as an “Anniversary Rule” in some contexts) for Medicare Supplement (Medigap) policies. This rule allows individuals with an existing Medigap policy to switch to a different Medigap plan with equal or lesser benefits around the anniversary of their existing policy or their birthday, without medical underwriting. This provides a crucial opportunity for New Jersey residents to shop for more competitive premiums or adjust their coverage without being penalized for pre-existing conditions. [Source: Medigap Seminars – Medicare Supplement Birthday Rule]
How do Medicare Advantage plans in New Jersey differ from Original Medicare?
Medicare Advantage (Part C) plans are offered by private companies approved by Medicare. They essentially bundle your Original Medicare (Part A & B) benefits, and typically include prescription drug coverage (Part D) and additional benefits like routine dental, vision, hearing, and gym memberships, which Original Medicare does not cover. While many have $0 monthly premiums beyond your standard Part B premium, they often involve network restrictions (HMOs or PPOs) and fixed copayments/coinsurance for services, along with an annual out-of-pocket maximum that provides financial predictability.
When can I enroll in Medicare in New Jersey?
Your primary enrollment window is your Initial Enrollment Period (IEP), a 7-month period around your 65th birthday (3 months before, your birthday month, and 3 months after). Key periods for changes or new enrollment include the Annual Enrollment Period (AEP) from October 15 to December 7 each year, and the Medicare Advantage Open Enrollment Period (MA OEP) from January 1 to March 31 each year.
Medicaid: A Vital Lifeline for New Jerseyans
New Jersey’s Medicaid program, known as NJ FamilyCare, provides essential health coverage to eligible low-income individuals and families. Significantly, New Jersey expanded its Medicaid program under the Affordable Care Act, extending coverage to many more low-income adults. This expansion has been crucial in lowering the state’s uninsured rate. Qualified NJ residents of any age may be eligible for free or low-cost healthcare coverage that covers doctor visits, prescriptions, vision, dental care, mental health and substance use services, and even hospitalization. As of January 1, 2023, children under 19 may apply for NJ FamilyCare regardless of their immigration status. [Source: NJ FamilyCare]
How Medicaid Benefits New Jersey Residents:
- Comprehensive Coverage: NJ FamilyCare provides extensive medical, dental, vision, and mental health care for eligible low-income individuals, children, pregnant individuals, parents, and adults with disabilities.
- Reduced Uninsured Rate: Medicaid expansion has played a critical role in increasing access to care for vulnerable populations, helping to lower New Jersey’s overall uninsured rate.
- Support for Families: NJ FamilyCare includes children’s health coverage, ensuring even more young residents have access to vital services.
Medicaid FAQs for New Jersey Residents:
Who is eligible for NJ FamilyCare (Medicaid) in New Jersey?
Eligibility in New Jersey is primarily based on income and specific categories. Thanks to Medicaid expansion, eligibility extends to:
Resource: For detailed eligibility guidelines, visit NJ.gov – Adults on NJ FamilyCare.
Adults aged 19-64 who live in New Jersey and are U.S. Citizens or qualified immigrants, with total family income at or below 138% of the Federal Poverty Level (FPL). For a single person in 2025, that’s approximately $1,800/month.
Pregnant individuals and children.
Parents and caretakers.
Individuals determined blind or disabled.
How do I apply for NJ FamilyCare?
You can apply for NJ FamilyCare through several methods:
Resource: For application instructions and required documents, see Morris County, NJ – Apply for Medicaid.
Online: Visit NJFamilyCare.org.
By Phone: Call 1-800-701-0710 (TTY: 711).
In Person: Contact your local County Board of Social Services.
What services does NJ FamilyCare cover?
NJ FamilyCare provides comprehensive coverage for a wide range of services including doctor visits, eyeglasses, hospitalization, lab tests, X-rays, prescriptions, regular check-ups, mental health, dental care, preventive screenings, autism services, community doula services, and help with personal care needs. [Source: NJ FamilyCare – What Does It Cover?]
Is there a waiting period for coverage after applying for NJ FamilyCare?
The processing time for an NJ FamilyCare application can vary, often taking between 45 and 90 days. It’s recommended to follow up with your case worker (whose contact information you’ll receive in a letter within 7-10 business days after applying) for updates on your application status
What happens if I lose my health coverage through an employer or Medicaid in New
Jersey?
You may qualify for a Special Enrollment Period to sign up for a new plan. Contact EIMA
Health for help getting covered quickly.
What will my insurance cover?
All ACA plans must cover doctor visits, prescriptions, hospital care, emergency services,
maternity and newborn care, mental health services, preventive screenings, pediatric care,
and treatment for pre-existing conditions.
The Affordable Care Act (ACA): Expanding Access and Affordability
For New Jerseyans who don’t have access to employer-sponsored insurance, including the self-employed, gig workers, and those working for small businesses that don’t offer coverage, Get Covered New Jersey is the state’s official health insurance Marketplace. New Jersey runs its own state-based marketplace, making it a tailored resource for residents. In 2024, over 325,000 New Jersey residents selected a plan through Get Covered New Jersey. [Source: Get Covered NJ – New Customers]
How the ACA Benefits New Jersey Individuals, Families, and Small Businesses:
- Exceptional Affordability: New Jersey residents qualify for record levels of financial help. Thanks to a combination of federal (American Rescue Plan Act and Inflation Reduction Act) and state subsidies (New Jersey Health Plan Savings), many New Jerseyans can get quality coverage for less than $10 a month. Nine out of 10 residents enrolling at Get Covered New Jersey qualify for financial help. [Source: Get Covered NJ – FAQs]
- No Pre-Existing Condition Denials: A fundamental consumer protection, insurers cannot deny coverage or charge more due to pre-existing health conditions.
- Essential Health Benefits: All plans offered through Get Covered New Jersey cover the 10 essential health benefits mandated by the ACA, providing comprehensive care from preventive services to emergency care.
- “Family Glitch Fix”: The “family glitch” was addressed in 2023, allowing family members of workers who are offered “unaffordable” employer coverage to qualify for Marketplace subsidies, opening up new affordable options for thousands of New Jersey families.
Affordable Healthcare FAQs for New Jersey Residents:
What is GetCoveredNJ?
It’s the official marketplace where you can compare health plans, apply for savings, and
enroll in ACA-compliant coverage.
How do I enroll?
You can apply online or work with Emily at EIMA Health for free help choosing and
applying for the best plan.
How do I qualify for financial help (subsidies) on Get Covered New Jersey?
You qualify for financial help (premium tax credits and New Jersey Health Plan Savings) based on your household income and family size. New Jersey’s state and federal changes mean that record levels of savings are available, potentially making coverage affordable even for those who didn’t qualify in the past. You can get an estimate using the “Shop and Compare” tool on Get Covered New Jersey. [Source: Get Covered NJ – FAQs]
What are the types of financial help available through Get Covered New Jersey?
When you apply, you might qualify for three types of financial assistance:
- Advance Premium Tax Credits (APTC): Federal subsidies that lower your monthly premium payments.
- New Jersey Health Plan Savings: A state subsidy unique to New Jersey that provides additional savings.
- Cost-Sharing Reductions (CSRs): Federal subsidies that lower your out-of-pocket costs (deductibles, copayments, coinsurance) for those who enroll in Silver plans and meet income criteria.
When is the Open Enrollment Period for Get Covered New Jersey for 2025 plans?
The annual Open Enrollment Period for 2025 plans in New Jersey is November 1, 2024 – January 31, 2025. This is the primary time to enroll or change your plan for the upcoming year. [Source: HealthMarkets – When Is Open Enrollment 2024-2025?]
Can I enroll in a plan outside of Open Enrollment if I live in New Jersey?
Yes, you can enroll outside of OEP if you qualify for a Special Enrollment Period (SEP) due to a Qualifying Life Event (QLE). Common QLEs include losing other health insurance (e.g., job loss, aging off a parent’s plan), getting married or divorced, having a baby, or moving. New Jersey also offers an “Expanded Access Special Enrollment Period” for consumers with yearly income up to 200% FPL, allowing them to apply any time of year. [Source: NJ.gov – Special Enrollment Period (SEP) Overview]
The EIMA Health Advantage: Your Partner in New Jersey Healthcare
For many New Jerseyans, navigating the intricacies of Medicare, Medicaid, and the ACA can feel like deciphering a complex puzzle. The thought of comparing plans, understanding eligibility criteria, and completing lengthy applications can be overwhelming, leading some to postpone or avoid securing vital coverage.
This is where EIMA Health Insurance excels. While we may be headquartered in Dallas, our commitment to providing clear, comprehensive, and compassionate guidance extends across the Garden State. We are your trusted advisors, ready to:
- Demystify the Process: We translate complex insurance jargon into easy-to-understand terms, ensuring you grasp every aspect of your options.
- Offer Comprehensive Options: We work with all available carriers across New Jersey’s Medicare, Medicaid, and ACA landscapes. We obtain and evaluate proposals, presenting you with a full spectrum of plans tailored to your specific needs.
- Provide Personalized Guidance: We take the time to listen to your unique circumstances as a family, individual, or business owner in New Jersey. Our goal is to find the perfect plan that aligns with your health needs, budget, and preferences.
- Walk You Through Every Step: From initial eligibility checks and detailed plan comparisons to seamless application submission and ongoing support throughout your coverage, we are with you at every stage of your insurance journey.
Don’t let the complexity of healthcare prevent you from securing the coverage you deserve. Contact EIMA Health Insurance today for a complimentary consultation. Let us empower you with the information and support you need to make informed decisions about your health and financial future in New Jersey.
Useful Local Resources for New Jersey Residents:
- Get Covered New Jersey: The state’s official Health Insurance Marketplace. https://www.nj.gov/getcoverednj/
- NJ FamilyCare: New Jersey’s publicly funded health insurance program (Medicaid & CHIP). https://njfamilycare.dhs.state.nj.us/
- NJ Department of Human Services: For information on Medicaid and other services. https://www.nj.gov/humanservices/
- New Jersey Department of Banking and Insurance (DOBI): For general insurance questions or complaints in New Jersey. https://www.state.nj.us/dobi/
- Medicare.gov: The official U.S. government site for Medicare. https://www.medicare.gov/