New Jersey residents have access to a wide range of health insurance options through the Affordable Care Act (ACA). Whether you are looking for marketplace coverage through Get Covered New Jersey, exploring NJ FamilyCare (Medicaid), or trying to understand your financial assistance options, this guide covers everything you need to know about New Jersey ACA benefits and coverage in 2026.
New Jersey operates its own state-based health insurance marketplace called Get Covered New Jersey, which replaced the federal HealthCare.gov platform in 2020. The state also has its own individual mandate, meaning residents who go without health insurance may face a penalty on their state tax return. Use our free benefits screener to quickly find out which programs you may qualify for.
What Does ACA Coverage Include in New Jersey?
All ACA marketplace plans sold through Get Covered New Jersey must cover ten essential health benefits. These benefits apply to every plan regardless of which metal tier you choose:
- Ambulatory patient services (outpatient care)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services, including chronic disease management
- Pediatric services, including oral and vision care for children
In addition, ACA plans in New Jersey cannot deny you coverage or charge you more for pre-existing conditions. Children can stay on a parent's plan until age 26.
Understanding Plan Metal Tiers
Get Covered New Jersey offers plans in four metal tiers plus a catastrophic option for some enrollees. Each tier reflects how costs are shared between you and the insurance company:
| Plan Tier | You Pay (Avg.) | Insurer Pays (Avg.) | Best For |
|---|---|---|---|
| Bronze | 40% | 60% | Low premiums, healthy individuals |
| Silver | 30% | 70% | Moderate costs, subsidy eligible |
| Gold | 20% | 80% | Frequent medical visits |
| Platinum | 10% | 90% | High usage, lowest out-of-pocket |
| Catastrophic | High deductible | After deductible | Under 30 or hardship exemption |
Silver plans are especially valuable for lower-income residents because they are the only tier eligible for cost-sharing reductions (CSRs), which lower your deductible and copays in addition to premium subsidies.
Income Limits and Financial Assistance
New Jersey offers both federal and state-level financial help to lower the cost of marketplace coverage. Understanding where your income falls relative to the Federal Poverty Level (FPL) determines which type of assistance you can receive.
2025/2026 Income Guidelines by Household Size
| Household Size | NJ FamilyCare (Medicaid) up to 138% FPL | ACA Subsidies (APTC) 139% to 400% FPL | NJ Health Plan Savings up to 600% FPL |
|---|---|---|---|
| 1 | Up to $21,597/year | $21,598 to $62,400/year | Up to $93,900/year |
| 2 | Up to $29,194/year | $29,195 to $84,400/year | Up to $126,600/year |
| 3 | Up to $36,791/year | $36,792 to $106,400/year | Up to $159,300/year |
| 4 | Up to $44,388/year | $44,389 to $128,400/year | Up to $192,900/year |
Important note about 2026 subsidies: The enhanced federal subsidies that have been in place since 2021 are set to change. If Congress does not extend them, consumers with income over 400% FPL will no longer receive federal premium tax credits starting in 2026. However, New Jersey's state-funded Health Plan Savings program provides additional subsidies for residents with household incomes up to 600% FPL.
Types of Financial Assistance Available
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Advance Premium Tax Credits (APTC): Federal subsidies that lower your monthly premium, available to households between 139% and 400% FPL (or higher if enhanced subsidies continue).
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Cost-Sharing Reductions (CSR): Available only with Silver plans for households between 139% and 250% FPL. These reduce your deductible, copays, and out-of-pocket maximum.
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New Jersey Health Plan Savings: A state-funded program providing additional premium assistance for residents with incomes up to 600% FPL, regardless of federal subsidy changes.
NJ FamilyCare: Medicaid and CHIP
If your income falls below 138% FPL, you may qualify for NJ FamilyCare, which is New Jersey's Medicaid program. This program provides free or very low-cost health coverage. Key details include:
- Adults ages 19 to 64: Income up to 138% FPL ($21,597/year for a single person)
- Children ages 0 to 18: Medicaid up to 147% FPL; CHIP coverage up to 355% FPL
- Pregnant individuals: Income up to 200% FPL
- All children under 19 are eligible regardless of immigration status (as of January 2023)
NJ FamilyCare enrollment is open year-round. You do not need to wait for an open enrollment period. Apply online at NJ FamilyCare or call 1-800-701-0710.
For a complete overview of all available programs, visit our New Jersey Benefits Overview page.
How to Apply for ACA Coverage in New Jersey: Step by Step
Follow these steps to enroll in a health plan through Get Covered New Jersey:
Step 1: Check Your Eligibility
Before applying, use our free screener tool to get a quick estimate of which programs you may qualify for based on your income, household size, and ZIP code.
Step 2: Gather Your Documents
You will need the following information ready:
- Social Security numbers for all household members
- Immigration documents (if applicable)
- Proof of income (pay stubs, W-2s, tax returns)
- Information about any current health coverage
- Employer coverage details (if offered)
Step 3: Create an Account on Get Covered NJ
Visit GetCoveredNJ.com and create a new account. If you already have an account from a previous year, log in with your existing credentials.
Step 4: Complete Your Application
Fill out the application with your household and income information. The system will determine whether you qualify for:
- NJ FamilyCare (Medicaid/CHIP)
- Federal premium tax credits (APTC)
- Cost-sharing reductions
- New Jersey Health Plan Savings
Step 5: Compare and Select a Plan
Browse the available plans in your area. For 2026, five insurance carriers offer plans through Get Covered NJ. Compare plans based on:
- Monthly premium (after subsidies)
- Deductible amount
- Copay and coinsurance costs
- Provider network (make sure your doctors are included)
- Prescription drug coverage
Step 6: Enroll and Pay Your First Premium
Select your plan and complete enrollment. Pay your first monthly premium by the due date to activate your coverage. Coverage start dates depend on when you enroll:
- Enroll by December 31: Coverage starts January 1
- Enroll in January: Coverage starts February 1
Open Enrollment and Special Enrollment Periods
Open Enrollment
New Jersey's open enrollment period runs from November 1 through January 31 each year, which is longer than most other states. Starting in fall 2026, the enrollment window may shorten due to new federal rules requiring state-based marketplaces to end open enrollment by December 31.
Special Enrollment Periods
Outside of open enrollment, you can enroll or change plans if you experience a qualifying life event, including:
- Losing existing health coverage
- Getting married or divorced
- Having or adopting a child
- Moving to a new area
- Losing Medicaid or CHIP eligibility
- Becoming pregnant (New Jersey is one of the few states that allows this)
Year-Round Enrollment
Some groups can enroll at any time:
- Native Americans and Alaska Natives
- Individuals eligible for NJ FamilyCare (Medicaid/CHIP)
New Jersey's Individual Mandate
Unlike most states, New Jersey requires residents to maintain minimum essential health coverage. If you go without qualifying coverage and do not have an exemption, you may owe a penalty on your state income tax return. The penalty amount is calculated similarly to the former federal penalty.
Exemptions are available for financial hardship, religious objections, short coverage gaps (under three months), and other qualifying circumstances.
Who Offers Plans on Get Covered NJ?
For the 2026 plan year, five insurance carriers offer coverage through the marketplace:
- AmeriHealth New Jersey
- Horizon Blue Cross Blue Shield of New Jersey
- Oscar Health
- Ambetter from WellCare
- UnitedHealthcare
Plan availability varies by county, so the options in your area depend on where you live. The average monthly premium after subsidies for 2025 plans was approximately $179 per month, though your actual cost depends on your income, age, location, and plan selection.
Frequently Asked Questions
How much does ACA health insurance cost in New Jersey?
Costs vary widely based on your income, household size, age, and the plan you select. Many New Jersey residents qualify for federal and state subsidies that significantly reduce premiums. Some enrollees pay as little as $0 per month after subsidies. Use our screener tool to estimate your costs.
Can I get ACA coverage if my employer offers insurance?
You can always purchase a marketplace plan, but you may not qualify for subsidies if your employer offers coverage that is considered affordable and meets minimum value standards. If your employer plan costs more than about 9.02% of your household income for employee-only coverage, you may still qualify for marketplace subsidies.
What happens if I miss open enrollment?
If you miss the November 1 to January 31 open enrollment window, you will need a qualifying life event to enroll during a special enrollment period. Otherwise, you will need to wait until the next open enrollment period. Going without coverage may result in a state tax penalty.
Is NJ FamilyCare the same as Medicaid?
Yes. NJ FamilyCare is New Jersey's name for its Medicaid and CHIP programs. It covers low-income adults, children, pregnant individuals, and people with disabilities. Enrollment is open year-round.
Do I qualify for free health insurance in New Jersey?
You may qualify for free or very low-cost coverage through NJ FamilyCare if your income is below 138% FPL. Even on the marketplace, some residents qualify for $0 premium plans after subsidies are applied. Check your eligibility with our free screening tool.
What is the New Jersey Health Plan Savings program?
This is a state-funded program that provides additional premium subsidies for Get Covered NJ enrollees with household incomes up to 600% of the federal poverty level. It supplements federal subsidies and helps keep coverage affordable for middle-income residents.
Can undocumented immigrants get health coverage in New Jersey?
While undocumented adults are not eligible for marketplace plans or standard Medicaid, New Jersey provides NJ FamilyCare coverage to all children under 19 regardless of immigration status. Some community health centers also offer services on a sliding fee scale.
Get Started Today
Finding the right health coverage in New Jersey does not have to be complicated. Start by using our free benefits screener to see which programs you may qualify for in just a few minutes. You can also visit Get Covered New Jersey directly or call 833-677-1010 for personalized help from a trained enrollment specialist.
For more information about all available benefit programs in New Jersey, check out our New Jersey Benefits Overview page.
