Insurance - Medicare - Retirement
The federal government recently passed a COVID-19 relief bill, the American Rescue Plan Act of 2021, which was signed into law by
President Biden on March 11, 2021. The new law will reduce health insurance premiums by providing more financial help to eligible consumers who purchase a plan through Get Covered New Jersey. Get
Covered New Jersey is working to implement the changes and update its system to ensure that New Jerseyans receive this relief as soon as possible.
More people than ever will qualify for financial help. If you did not qualify for financial help before because your income was too high, you may qualify under the federal changes. If you already receive financial help, you will likely be eligible for additional premium reductions. These new changes make coverage more affordable at many income levels.
During the COVID-19 pandemic, the State of New Jersey has remained focused on improving residents’ access to quality, affordable health
insurance. The financial help available through this relief bill builds on the state’s efforts to provide access to health coverage for more New Jerseyans.
Here are more details on what you can expect:
GetCoveredNJ will be working to ensure these new benefits are implemented in a timely manner. Check back to this page for updates. All
enrolled consumers should be sure to read any notices sent by GetCoveredNJ.
A: Get Covered New Jersey is working as quickly as possible so consumers can see these benefits in the near future. We will provide
updates on our website in the coming weeks about when the benefits will be available. Current enrollees will be notified when the benefits are available and any action that needs to be taken to
A: Yes, you will be able to change your coverage based on any additional financial help you may receive.
A: Financial help is still based on your individual household income. The amount you and/or your family make yearly will determine how
much financial help you will receive.
A: There are low cost plans available now and you can enroll through the COVID-19 Special Enrollment Period. If you need coverage, you should check out your options. Consumers will be provided information about how to obtain the new financial help once it is available.
Get Covered New Jersey, the state’s official health insurance marketplace, has announced a COVID-19 Special
Enrollment Period from February 1, 2021 to May 15, 2021 for all eligible residents seeking health insurance at this critical time. Visit GetCovered.NJ.gov to shop and compare plans and see if
you qualify for financial help.
A: Yes. The Open Enrollment Period ran from November 1, 2020 through January 31, 2021. Governor Murphy announced on January 29, 2021 an extension of the enrollment window for New Jerseyans seeking coverage to May 15, 2021 through a COVID-19 Special Enrollment Period. Extending the enrollment timeframe for those who need insurance to May 15, 2021 helps to better protect New Jersey residents at this critical time.
A: No. Residents do not need to be directly impacted by the coronavirus in order to enroll in a plan through the COVID-19 SEP, and no documentation will be required to demonstrate a direct impact of COVID-19. All eligible residents in need of health insurance can enroll through May 15, 2021.
A: It depends. No documentation specific to COVID-19 is required for eligible residents to enroll in a plan through the COVID-19 Special Enrollment Period. Coverage will take effect on the first day of the month following a plan selection through the COVID-19 SEP.
The coverage effective dates are as follows:
Enroll by February 28, coverage effective March 1;
Enroll by March 31, coverage effective April 1;
Enroll by April 30, coverage effective May 1;
Enroll by May 15, coverage effective June 1.
Coverage effective dates may vary for SEPs specific to a life-changing event, allowing for an earlier effective date. Additionally, some
SEPs specific to a life change require verification documentation.
Certain events, such as having a baby and adopting a child are qualifying life events that provide for SEP enrollment back to the date of
the event. Additionally, pregnancy is a new NJ-specific qualifying life event that allows for SEP enrollment back to the month of the confirmed pregnancy. If you need retroactive coverage related to
these events, you may apply through the SEP specific to your life event. (Note: Pregnancy, adoption and birth do not require verification documentation).
A: Loss of Minimum Essential Coverage requires documentation to verify the loss of coverage and allows 60 days from the event to enroll
in a plan. Coverage can start the first of the month after you apply and enroll. If you know you are losing coverage within the next 60 days, you can submit an application on GetCovered.NJ.gov before
you lose your coverage to ensure you can stay covered throughout the year. For example, if you know you’ll lose coverage on February 28, and you apply and enroll in plan on February 10, your new
coverage will start March 1.
If you lose coverage and become uninsured, you can enroll through the COVID-19 Special Enrollment Period without providing documentation.
Your coverage will begin on the first day of the month following your plan selection.
A: Yes. Special Enrollment Periods are available throughout the year for residents who have a major life change, called a qualifying life event (QLE), which allow for enrollment outside of the open enrollment period. Certain QLEs also allow for enrollees to change their existing plan. They include: birth, adoption, marriage, death, dependent aging off coverage, moving, income loss that changes eligibility for Marketplace coverage (for example, newly qualifies you for financial help). Remember to update your application with any income or household changes as it may impact your financial help. Additionally, changes to current coverage unrelated to a specific life event can be made through the COVID-19 Special Enrollment Period.
A: Errors made by a health insurance carrier or by the program qualify you for an Exceptional Circumstance Special Enrollment Period.
Documentation of the error will be required (see standard form
here). Your coverage may be retroactively updated back to the date of the error, if applicable.
A: The COVID-19 SEP will allow eligible residents in need of coverage to enroll in a plan through May 15, 2021.
To enroll, visit GetCovered.NJ.gov. Select “2021 COVID-19 Enrollment Period” when submitting your application.
Trained navigators and brokers can help you enroll by phone, virtually, and may have in-person availability. Information may be found on our website under Find Local Assistance. You may also call our Consumer Assistance Center: 1-833-677-1010.
If you are eligible for NJ FamilyCare, the state’s publicly funded low or no cost health insurance program (Medicaid or Children’s Health Insurance Program), you can
enroll any time of year.
A: Yes. The state established a COVID-19 Special Enrollment Period for enrollment in plans available through Get Covered New Jersey and
directly from insurance carriers in the individual market. All available plans may be viewed by using our Shop and Compare tool.
Yes. Health insurance companies are required to waive cost-sharing, including lab fees, co-payments, coinsurance, and deductibles for any
visit to test
for coronavirus at a doctor’s office, urgent care center, or emergency room, and for a coronavirus vaccine. Additionally, if the
primary purpose of an office visit is the delivery of the COVID-19 immunization, then insurance companies may not impose cost-sharing requirements for the office visit.
Yes. All eligible New Jerseyans in need of coverage may qualify for this COVID-19 Special Enrollment Period.
Additional information about Special Enrollment Periods may be found on our When Can I Buy Insurance page.
New Jersey Department of Health: https://www.nj.gov/health/
Centers for Disease Control and Prevention: https://www.cdc.gov/
Special Enrollment Period (SEP)
A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period
if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for an SEP, you usually have up to 60 days
following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply.
There are 4 basic examples of qualifying life events.
Documents must show that you lost qualifying health coverage in the past 60 days or will lose coverage in
the next 60 days. These documents must include your name and the date of coverage loss. Documents you can submit:
You can also submit any of the documents in the list below. However, these documents may include only some of the information we need to confirm, so you’ll most likely need to submit more than one of these documents:
You can submit a letter explaining the coverage you had, why and when you lost it or will lose it, and the reason you can't provide documents.
Christopher S. Kudryk
KBenefits provides insurance solutions for small business owners and individuals in NJ & NY. Contact KBenefits today and see how we can benefit you.
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