ObamaCare in New Jersey
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About Obamacare in New Jersey
The Health Insurance Marketplace is a new methodology to get health coverage in New Jersey. Marketplace plans offer essential health benefits provided by private insurance companies. Each plan has different benefits, costs and features. You can compare between plans to decide which one better adapts to your needs. When you submit a Marketplace application, you will find out if you qualify for free or low-cost coverage, based upon your income and your household size. If you are not enrolled in a healthcare program, you may be subject to penalties that will be paid in your 2015 income taxes.
Penalties will represent one percent of your income or $95 per adult ($47.50 per child). There might be exceptions to the penalty, for example, if the lowest-cost plan is equivalent to more than eight percent of your total household income. The enrollment cycle was closed on March 31st, 2014. The new enrollment period will start on November 15th, 2014. You can review more information regarding Health Insurance Marketplace at: https://www.healthcare.gov.
Individual & Family Coverage
This affordable healthcare program provides coverage for basic care, including medical consultations, emergency care and drug prescriptions. In NJ, when you fill a prescription at a pharmacy, your plan will help you pay for certain medications. You can get a benefit summary so you can see the list of the medications covered under your plan to ensure they are part of the approved list. You can also review the in-network pharmacies.
When visiting a healthcare provider, you will be able to select the doctor of your choice. However, in-network doctor appointments will probably imply lower out-of-pocket payments. Your plan will cover emergency care at any hospital; your insurance company cannot charge you more for out-of-network emergency room services.
If your business has fewer than 50 full-time employees you won’t be subject to the Employer Shared Responsibility law, meaning that you are not obliged to provide health insurance for your employees. Nevertheless, you can decide to use the Small Business Health Options Program (SHOP) Marketplace to provide healthcare coverage. Getting a plan through SHOP means you may qualify for a small business health care tax credit if you have less than 25 full-time employees. The tax credit can be worth up to 50 percent of the premium costs. Non-profit organizations are also eligible for SHOP.
The SHOP Marketplace offers four coverage levels: Bronze, Silver, Gold and Platinum. You may choose the one that better works for your business and coverage can begin at any time of the year. The small business employer can decide how much to pay towards the employee premiums.
Coverage for pre-existing conditions has to be provided by all Marketplace plans in New Jersey, except grandfathered individual health insurance plans purchased before March 23, 2010. If you have a grandfathered plan, you may switch to a Marketplace plan and receive coverage for pre-existing conditions. If you get a plan through Marketplace, your insurance company cannot turn you down due to a pre-existing condition like cancer, diabetes or asthma. The same rules apply to Medicaid and the Children’s Health Insurance Program (CHIP). Treatment for any pre-existing medical condition is still subject to your plan’s deductibles and copayment, the same way they apply for new health conditions.