Healthcare Overview

Healthcare has always been an important consideration. For many in our state, it has become a critical concern. Here is a review of the health resources available in New Jersey. If you need help finding the resource that is right for you, dial 2-1-1 and let one of our experienced resource specialists help you.

The Affordable Care Act (ACA)

Open Enrollment Periods
You must enroll for insurance coverage every year, even if you currently have insurance. Open enrollment for each new calendar year (January 1 - December 31) begins on November 1 of the year prior to the upcoming calendar year and ends on January 31 of the calendar year for which you are seeking coverage. For coverage to start on January 1, you will need to apply by December 15. Learn more about this and where you can go to get help with enrollment here.

Medical Assistance Programs

There are several medical assistance programs that are jointly administered and funded by the state and federal government.

    • Medicaid is designed to help those with very limited or no income. 
    • NJ FamilyCare is New Jersey's publicly funded health insurance program and includes CHIP (Children's Health Insurance Program), Medicaid and Medicaid expansion populations. This program is geared to help New Jersey’s uninsured children and parents and guardians who fall within certain income criteria. Qualified NJ residents of any age may be eligible for free or low cost health insurance that covers doctor visits, prescriptions, vision, dental care, mental health and substance use services and even hospitalization.
    • Medicare is set up to help senior citizens or those who are permanently disabled.

To be eligible for Medicaid

This medical assistance program pays medical bills for certain individuals of any age with low income and limited resources. To be eligible you must be:

    • A resident of NJ
    • U.S. Citizen or qualified alien (most immigrants who arrived after August 22, 1996 are barred from the program for five years)
    • Meet specific standards for financial income and resources

To apply for Medicaid, contact your County Board of Social Services.

NJ FamilyCare

If you are NOT eligible for Medicaid because you fall above the income requirements, you may be able to get medical benefits through NJ FamilyCare. NJ FamilyCare is for families who do not have available or affordable employer insurance, and cannot afford to pay the high cost of private health insurance.

To learn more about this program and eligibility requirements, go to the NJ FamilyCare or call 800-701-0710. Applications are available online.

Medicare

Medicare is for senior citizens and those with a disability. If you are 65 years or older; under the age of 65 with certain disabilities or have permanent kidney failure which requires dialysis or a transplant, then you are eligible for Medicare.

Medicare has two main parts – one that covers hospital costs and another that handles some related expenses.

Part A is hospital insurance and it helps people pay for inpatient hospitalizations, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care.

Part B is medical insurance that people pay a monthly premium for. It helps people pay for doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

To enroll in Medicare, contact your local Social Security office or call 800-772-1213 to learn more. If you are deaf or hard of hearing call the TTY number, 800-325-0778.

Private Insurance Options

In addition to the options made available through the Affordable Care Act, the following health insurance coverage is available to New Jersey residents.

The Individual Health Coverage (IHC) Program was created to ensure that people without access to employer or government sponsored healthcare programs could purchase health coverage for themselves and their families from a variety of private carriers.

Individuals, regardless of their age or health status, are guaranteed renewable health coverage under standard individual health benefits plans designed by the Individual Health Coverage Program Board.

Learn more about the Individual Health Coverage (IHC) Program, the current rates and coverage options.

Insurance Policies for Small Business Owners

The Small Employer Health Benefits (SEH) Program ensures that small employers have access to small group health benefits plans without regard to the occupation of the group, or the health status of any of the group's members; and that these employers have the ability to renew the coverage from year-to-year regardless of the group's claims experience or any changes in the health status of the group's members.

The Program restricts carrier use of small group participation requirements, employer contribution requirements, preexisting condition limitation provisions, and factors related to rates for health benefits plans offered to small employers. It also establishes standard health benefits plans. In addition, the Program protects employees and past employees because it includes a right for employees and their dependents to continue coverage when no longer eligible for the group's health plan. This continuation right applies even when an employer is not subject to COBRA.

Learn more about insurance coverage options for small employers.

Sources for this page include:

http://www.state.nj.us/health/senior/index.shtml 

http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ 

http://www.njfamilycare.org/index.html

http://www.state.nj.us/dobi/division_insurance/ihcseh/index.html 


Page last modified/reviewed on October 26, 2016

If you know of additional resources that would be appropriate to include in this section, please let us know by contacting us via e-mail at info@nj211.org

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