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2019 Open Enrollment

Below is information regarding the 2019 open enrollment period for the Affordable Care Act’s Individual Market plans (aka “ACA” or “Obamacare” plans).  This year, HealthCare.gov allows for “window shopping” to allow individuals to preview plan options and price estimates before starting an application, which is an exciting new feature that will help your constituents understand their health insurance options before making any commitments.  The New Jersey Association of Health Plans, a non-profit association representing leading health care plans in the state which cover over seven million New Jersey residents, is providing this information to help you and your staff assist your constituents. We hope you find the attached information helpful.  The New Jersey Association of Health Plans welcomes any questions you may have and is ready to act as a resource on any health-coverage issues.  2019 Individual Market Open Enrollment Information

Q:  What is an open enrollment period? The yearly period when people can enroll in a health insurance plan. Generally, you are not permitted to sign up for coverage outside the open enrollment period.  There are exceptions if you qualify for a “Special Enrollment Period,” which is for people who experience certain life events, like getting married, having a baby, or losing other health coverage.

Q:  When is the open enrollment period for individual market coverage in 2019? Open Enrollment for 2019 runs from Thursday November 1, 2018 to Saturday December 15, 2018.  If consumers want to enroll or re-enroll in coverage, either on the “Obamacare” exchanges or off-exchange for 2019, they must do so during this time period.  This year’s open enrollment is the same length as last year.  However, this is shorter than in the years prior to 2017 and federal funding for consumer outreach and advertising has been reduced, so consumers may be unaware of these dates.  While outreach efforts at the federal level have been minimized, New Jersey has proactively taken significant steps for residents to obtain information about their coverage options.  Learn more about these efforts at GetCovered.NJ.gov.

Q:   Are there penalties for not having insurance? Not from the Federal Government.  In previous years, if a taxpayer did not have coverage or qualify for an exemption he/she must pay an “individual responsibility tax.” As a result of the tax reform bill signed into law in late 2017, the federal penalty has been eliminated. However, New Jersey has implemented an individual mandate beginning in 2019 and there will be a penalty for those who do not have coverage.  The mandate mirrors the federal mandate that has since been eliminated. If a taxpayer does not have coverage or qualify for an exemption he/she must pay a “shared responsibility tax,” which is the greater of either a fixed dollar amount (adjusted annually; in 2017 it was $695 per adult and $347.50 per child) or 2.5 percent of household income above the tax filing limit. Learn more about the New Jersey individual mandate at https://www.state.nj.us/treasury/njhealthinsurancemandate/.

Q: Where can I go to shop for coverage or find trusted information? • To see if you qualify for a subsidy, go to Healthcare.gov or Call 1-800-318-2596.  For 2019, you can get health plan options and cost estimates based on your income before logging into the website or starting an application. • Visit GetCovered.NJ.gov for additional resources in New Jersey. • The Individual Health Coverage Board (“IHC”) at the Department of Banking Insurance (“DOBI”) publishes this excellent New Jersey Individual Market Buyer’s Guide.  It has information about eligibility, coverage options, and much more. There is also a Shopping Guide that may help consumers decide which plan is best for them.   • Also, the IHC Board/DOBI’s website has additional information about shopping for individual and small employer (1-50 employees) market coverage including an overview of rates.  You can access that information here.

Q:  What insurance carriers offer coverage to individuals and their families on the exchange (with subsidies available for those below 400% of the federal poverty limit)?   Carrier Website Phone AmeriHealth HMO Inc. and AmeriHealth Ins. Co. www.amerihealthnj.com 1-877-744-5422 Horizon Blue Cross Blue Shield of NJ www.horizonblue.com 1-800-224-1234  Oscar Garden State Insurance Corp. www.hioscar.com 1-855-672-2788

Q:  Are there other coverage options for individuals and families off of the exchange? While plans on the exchange are available for purchase regardless of whether or not the individual/family is eligible for a subsidy, there are also coverage options off-exchange.  In New Jersey, the following carriers have plans that are not on the exchange available for purchase:    Carrier Website Phone AmeriHealth HMO Inc. and AmeriHealth Ins. Co. www.amerihealthnj.com 1-877-744-5422 Horizon Blue Cross Blue Shield of NJ and Horizon HealthCare of NJ www.horizonblue.com 1-800-224-1234 Oscar Garden State Insurance Corp. www.hioscar.com 1-855-672-2788 Oxford Health Insurance (NJ) Inc. www.oxhp.com 1-800-273-8115

Q: What if I qualify for other public programs like New Jersey FamilyCare, the Children’s Health Insurance Program or Medicaid?  Will the Health Insurance Marketplace (HealthCare.gov) automatically refer my information? Yes, if it looks like anyone in your household qualifies for Medicaid or the Children’s Health Insurance Program, also known as New Jersey FamilyCare, the HealthCare.gov website will refer your information directly to the FamilyCare program.

Q: Someone in my household may qualify for New Jersey FamilyCare, but we missed the open enrollment deadline, can I still apply? Yes, you may apply at any time for New Jersey FamilyCare, your eligibility for enrollment will be determined by other factors.  An enrollment representative is available live at 1-800-701-0710 during the following hours:  • Monday and Thursday between 8:00am and 8:00pm  • Tuesday, Wednesday or Friday between the hours of 8:00am and 5:00pm

Q:  What if I wanted to find out more information about New Jersey FamilyCare or apply for coverage directly? NJ FamilyCare – New Jersey’s publicly funded health insurance program – includes CHIP, Medicaid and Medicaid expansion populations. That means 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.  The New Jersey FamilyCare website provides multilingual support. For more information and to apply online, go to: http://www.njfamilycare.org/default.aspx.    Also, an enrollment representative is available live at 1-800-701-0710 during the following hours:  • Monday and Thursday between 8:00am and 8:00pm  • Tuesday, Wednesday or Friday between the hours of 8:00am and 5:00pm