Key Facts
NJ FamilyCare (Medicaid) in New Jersey
New Jersey expanded Medicaid in 2014, providing comprehensive coverage through NJ FamilyCare. This program serves as the state's Medicaid and CHIP program, offering free or low-cost health coverage to eligible residents. New Jersey has one of the more generous Medicaid programs in the nation.
Who Qualifies for NJ FamilyCare?
- Adults ages 19-64 with income up to 138% FPL ($20,783/year for individuals)
- Pregnant women with income up to 205% FPL
- Children under 19 with income up to 355% FPL
- Seniors and people with disabilities meeting income and asset requirements
- Parents/caretakers with income up to 138% FPL
NJ FamilyCare Benefits
- Preventive care and wellness visits
- Doctor visits and specialist care
- Hospital inpatient and outpatient services
- Prescription drug coverage
- Mental health and substance abuse treatment
- Dental services (comprehensive for children)
- Vision care
- Laboratory and X-ray services
- Family planning services
How to Apply
You can apply for NJ FamilyCare through:
- Online at njfamilycare.org
- By phone: 1-800-701-0710
- In person at your local County Board of Social Services
- Through a certified application counselor or navigator
Get Covered New Jersey Marketplace
New Jersey launched its own state-based health insurance marketplace, Get Covered New Jersey, in 2021. This gives the state more control over enrollment periods, plan offerings, and consumer assistance. If you earn more than 138% FPL or prefer private coverage, the marketplace offers comprehensive options.
Available Plan Types
- Bronze: Lower premiums, higher out-of-pocket costs (60% coverage)
- Silver: Moderate premiums and costs (70% coverage) - best for subsidies
- Gold: Higher premiums, lower out-of-pocket costs (80% coverage)
- Platinum: Highest premiums, lowest out-of-pocket costs (90% coverage)
Enrollment Periods
Open Enrollment: November 1, 2024 - January 31, 2025
New Jersey offers an extended open enrollment period compared to the federal marketplace. NJ FamilyCare accepts applications year-round. You can also qualify for a Special Enrollment Period if you have a qualifying life event.
Average Costs in New Jersey
New Jersey has some of the highest health insurance premiums in the nation due to the high cost of living and healthcare costs in the state. However, the individual mandate and strong marketplace competition help keep rate increases moderate. Here are typical monthly premiums before subsidies:
| Plan Type | Individual (Age 40) | Family of 4 |
|---|---|---|
| Bronze | $400 - $480 | $1,300 - $1,600 |
| Silver | $500 - $620 | $1,600 - $2,000 |
| Gold | $580 - $700 | $1,850 - $2,300 |
| NJ FamilyCare | $0 | $0 |
Frequently Asked Questions
Has New Jersey expanded Medicaid?
Yes, New Jersey expanded Medicaid in 2014. Adults with household incomes up to 138% of the Federal Poverty Level qualify for NJ FamilyCare, the state's Medicaid program.
What is GetCoveredNJ?
GetCoveredNJ is New Jersey's state-based health insurance marketplace where residents can shop for and enroll in qualified health plans. It launched in 2021 and offers coverage with potential subsidies based on income.
Does New Jersey require health insurance?
Yes, New Jersey has an individual mandate requiring most residents to have health insurance. Those without coverage may face a state tax penalty called the New Jersey Health Insurance Market Preservation Fee.
When is open enrollment for New Jersey health insurance?
Open enrollment for 2025 coverage through GetCoveredNJ runs from November 1, 2024 through January 31, 2025. New Jersey has an extended enrollment period compared to the federal marketplace.
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