The Affordable Care Act for New Jersey residents: Your health care reformed

The Affordable Care Act (ACA), also known as Obamacare, is a comprehensive health care reform law that President Barack Obama signed on March 23, 2010.

The law was designed to make health insurance more affordable — by making more people eligible for Medicaid, and also by making major changes to reduce costs in individual insurance markets.

The ACA also guarantees that you can’t be denied health insurance even if you're already sick. It requires every health plan to provide ten essential health benefits. And depending on your income, age, and household size, you may also be eligible for financial assistance (subsidies).

Until now, people in New Jersey who wanted to enroll in Obamacare used the national health insurance marketplace. But now, New Jersey has its own official new state health insurance marketplace, GetCoveredNJ.

Here’s what you should know about the Affordable Care Act and what it means for you.

Open Enrollment

During the Open Enrollment Period, anyone can sign up for new health insurance through the ACA, or switch plans, regardless of their situation. In New Jersey, Open Enrollment begins on November 1 and ends on January 31. New insurance plans go into effect on January 1 of the following year if you apply before December 31. If you apply between January 1 - 31, plans go into effect on February 1, assuming your first month’s premium has been paid.

Qualifying life events

You may not switch health insurance plans outside of the Open Enrollment period unless you’ve experienced a Qualifying Life Event (QLE). Below are examples of QLEs:

  • Loss of existing health coverage — for reasons like losing a job or turning 26 and no longer being covered by your parents’ insurance
  • Changes in household — such as getting married or divorced, having a new baby or adopting a child, or a death in the family
  • Changes in residence — for instance, moving to a new zip code, county, or state
  • Other qualifying events — including a change in your income, becoming a U.S. citizen, or leaving jail or prison

If your situation changes in any of these ways, you can apply for new health insurance at any time of year — as long as it’s during the Special Enrollment Period (SEP), within 60 days of the QLE. Learn more.

Five key parts of the Affordable Care Act

The Affordable Care Act has had a major effect on the types of health plans you can qualify for, how much you are asked to pay, and what benefits you'll receive. Here's why:

  1. Individual Mandate
    The State of New Jersey has an individual health insurance coverage mandate, which requires New Jersey residents to have health insurance or possibly pay a fine. This helps keep individuals’ insurance premiums lower, because it pools together all the health care consumers in a given area — both those who are likely to have very few medical issues and those who are likely to have very many.
  2. Help with costs
    If you have difficulty paying for health care, the government may help you pay for some or all of your health expenses. Those who qualify could either receive tax credits or be able to pay a lesser amount for a plan that meets their needs. That includes many people who don't already get help from the government. Beginning in 2021, the state of NJ also has an additional subsidy that residents can qualify for through the NJ Health Plan Savings (NJHPS) state subsidy.
  3. Full-time hours
    Employers with more than 50 employees are required to either provide health insurance coverage to their full-time employees or become ineligible for a subsidy.
  4. Guaranteed coverage
    You can enroll in a health plan even if you already have serious and expensive health problems. And you will not pay more because of your health problems.
  5. Ten essential health benefits
    Health insurance plans are required to offer these ten essential health benefits in all of their individual and small group health plans:
      
    • Preventive, wellness, and disease management services
      This includes annual physical exams, flu shots, gynecological exams, and birth control
    • Emergency care
      Treatment for broken bones, heart attacks, and other urgent health problems at a hospital emergency room
    • Ambulatory services
      Minor surgeries, blood tests, and X-rays
    • Hospitalization
      Treatment at a hospital for a condition that requires you to stay overnight or multiple days
    • Maternity and newborn services
      Care through the course of a pregnancy, delivery of the baby, and checkups after the baby is born
    • Pediatric services, including dental and vision
      Children’s well visits, shots to prevent serious health conditions, teeth cleanings, braces, exams, glasses, and contact lenses
    • Prescription drugs
      For instance, high blood pressure medicines, insulin, antibiotics, and birth control pills
    • Laboratory services
      Blood tests, urinalysis, and other kinds of lab tests
    • Mental health and substance use disorder services, including behavioral health treatment
      Getting help to deal with conditions like depression, alcohol abuse, and drug abuse
    • Rehabilitation and habilitation services
      For example, physical therapy, speech therapy, occupational therapy

In addition, you may not have to pay anything extra for many preventive services that can help you stay healthy. Some examples of preventive services are wellness visits, immunizations, and screenings for cancer and other diseases.

How the Health Care Law Protects You

Because of the ACA, health insurance companies that serve the people of New Jersey are required to provide certain benefits that they didn’t have to offer before. For example:

Before the ACANow
You could be denied health insurance if you had a pre-existing medical condition like diabetes, kidney failure, heart disease, or cancer. You cannot be denied coverage because of having a pre-existing condition, and you can’t be charged higher premiums because you have one.
Young adults stopped being covered by their families’ health insurance plans once they turned 18. Young adults can stay on their parent’s plans until age 26.
Health plans weren’t required to cover all of the same basic health services. All health plans now have to cover certain specific health services like regular doctor checkups and screenings, emergency room visits, drug prescriptions, and hospital stays.

Additional Rights and Benefits

Before the Affordable Care Act, health insurance plans used to vary a lot in terms of what types of services and products they covered. But now, all insurers must cover certain specific services and products, such as:

  • Breastfeeding equipment
    Health insurance plans must cover the costs of breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.
  • Birth control
    All plans must cover contraceptive methods and counseling for all women, as prescribed by a health care provider. When these services are provided by an in-network health care provider, plans may not charge a copayment or coinsurance — even if you haven’t met your deductible.
  • Treatment of mental health and substance use disorders
    All plans must cover mental health and substance abuse services as essential health benefits. These include behavioral health treatments like psychotherapy and counseling, inpatient mental and behavioral health services, and the treatment of substance abuse disorders.

For more information on the benefits required under the Affordable Care Act, visit healthcare.gov.

The ACA’s impact on company-provided health insurance plans

The Affordable Care Act has affected not only individual insurance plans but also the health insurance that is provided by employers. It requires businesses with more than 50 employees to either provide health insurance coverage to its full-time employees or pay a fine.

To shop for plans and enroll:

 New Jersey health insurance marketplaceDirectly with AmeriHealth New Jersey*
Online GetCovered.NJ.gov AmeriHealthNJ.com
Phone 833-677-4265 888-968-7241

For more details on how the Affordable Care Act affects you, visit GetCovered.NJ.gov.

*There may be cost-saving options available to you when applying directly with AmeriHealth New Jersey. However, when you apply directly with AmeriHealth New Jersey, you are not eligible for tax credits.