Do you still need health insurance?

The annual Open Enrollment Period (OEP) to buy health insurance ended on January 31. However, a window of opportunity to purchase health coverage or change your plan may open after that date, depending on specific life changes a consumer may experience.

The state marketplace established under the Affordable Care Act (ACA) allows people with specific life-changing events to qualify for a Special Enrollment Period (SEP). But if you are eligible for an SEP, you should know that you usually have up to 60 days after the event to enroll or change your plan.

What is a life-changing event?

Household change: Marriage, divorce, legal separation, pregnancy, adoption, taking a minor under foster care, a court order, a death that makes the person ineligible for their previous coverage, or reaching age 26.

Changes in residence: Moving in or out of the coverage area, moving to New Jersey from another state or U.S. territory, or from a foreign country

Losing health insurance: Change or loss of employment or any other minimum essential coverage, or change in eligibility for Medicaid/CHIP.

Change of immigration status: Becoming a legal resident of the United States (permanent residence card, citizenship, H1-B visa, and others).

Change in your income: Suffering a loss of income or crossing the eligibility threshold for financial assistance. In these cases, you must report it within 30 days of its occurrence.

What's new for SEP in 2023

Unlike other consumers, those with an annual household income below 200% of the Federal Poverty Level (FPL) who therefore qualify for Get Covered NJ can enroll anytime and qualify for plans with monthly premiums as low as $0. In numbers, annual income below 200% FPL is:

• Individual: $27,180
• Family of two: $36,620
• Family of three: $46,060
• Family of four: $55,500

When does the SEP not apply?

To avoid confusion, the following do not qualify as an event to buy or change health insurance in a Special Enrollment Period:

• Dropping coverage voluntarily
• Loss of eligibility for coverage when the person was not enrolled in coverage (i.e., lost the job but was not on employer health plan).
• Being a person eligible for financial assistance who has not previously had health insurance
• Coverage terminated due to non-payment or fraud
• Divorce or death of a family member that does not result in a loss of coverage

The consumer needs to know that, during the enrollment process through the SEP, they can do what anyone else can do during the regular annual enrollment window. 

Among other things, you can compare plans and costs, find out what financial help you might be eligible for, find out if your doctors are in the network of the plan you're interested in, and obtain an estimate of the annual cost of your own healthcare and of your family.

If there are still questions, call us at (844) 303-2233 for help in English or Spanish. Our agents also speak Hindi, Urdu and Punjabi at (862) 781-0631.