Jeffrey Wade
Medicaid is a government-funded health insurance program for low-income individuals and families. It is a federal and state program that provides health coverage to millions of Americans. While Medicaid is a vital program, it has limitations, and some people may choose to purchase private insurance to supplement their coverage. So, can you use private insurance with Medicaid in New Jersey?
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What You'll Learn
NJ FamilyCare/Medicaid eligibility checks
New Jersey's Medicaid program is called NJ FamilyCare. It helps qualified residents with limited incomes get access to affordable health insurance. To be eligible, you must meet the income and resource limits for NJ FamilyCare/Medicaid and be part of one of the following groups:
- Aged 65 or older
- Under 65 and blind or disabled
- Meet the criteria for the level of care provided in a nursing facility
If you meet the eligibility requirements, you can enrol at any time. To apply, you will need to provide the following information:
- Proof of income, such as pay stubs, tax returns, or bank statements
- Other income, such as unemployment benefits, SSI benefits, pensions, or retirement, alimony, etc.
You can visit the New Jersey government websites to learn more about the financial eligibility requirements for NJ FamilyCare/Medicaid and to start the application process.
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Medicaid financial assistance
Medicaid provides free or low-cost medical benefits to eligible individuals with low incomes. Each state has its own requirements for eligibility, and you must be a resident of the state where you are applying for benefits. To apply for Medicaid, you can create an account with the Health Insurance Marketplace and fill out an application. If it looks like you qualify for Medicaid, your information will be sent to your state agency, and they will contact you about enrollment.
When you apply for Medicaid, you may need to provide certain information or documentation. Your state Medicaid agency may ask for details of any insurance plans offered by your employer or any insurance plan you currently have. Your state may also review your information each year to decide if you are still eligible for Medicaid. If they need more information, they will contact you about renewing your coverage.
Not every provider accepts Medicaid, so it is worth checking with your state's Medicaid agency to find a suitable provider. If your income is too high for Medicaid, your child may still qualify for the Children's Health Insurance Program (CHIP). This program covers medical and dental care for uninsured children and teens up to age 19.
In addition to Medicaid and CHIP, there are other government programs that may help pay for medical and other basic living expenses, such as food, housing, and energy bills. You can contact your state social service agency for more information about these programs.
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NJ FamilyCare/Medicaid renewal packets
To keep your benefits and services, you must renew your NJ FamilyCare/Medicaid coverage every year. NJ FamilyCare will send you a renewal notice in the mail, which may be a pre-printed form or a blank application. You should send your completed renewal form back before the due date specified in your renewal notice. The address to send it to will also be included in the notice.
If you don't receive a renewal form, or you're unsure when your renewal date is, you can call your NJ FamilyCare county office. You can also get help with the renewal process in person by choosing your county to find a list of local agencies that can help you renew.
When you renew, you may need to include the following with your application:
- Your most recent pay stub with your gross wages or a letter from your employer on company letterhead with your gross wages
- Proof of any other form of income (self-employment, rental, alimony, etc.)
Since March 2020, NJ FamilyCare/Medicaid has followed special rules related to the federal COVID-19 Public Health Emergency (PHE). These rules allowed members to keep their health coverage even if they no longer qualified, for example, if their income was too high. In April 2023, NJ FamilyCare resumed eligibility renewals, with the federal government giving states 12 months to redetermine all members' eligibility for Medicaid.
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GetCoveredNJ
In New Jersey, Medicaid enrollment is handled by NJ Family Care or GetCoveredNJ, the state-run health insurance marketplace. Individuals and families can shop for and purchase affordable healthcare coverage through GetCoveredNJ.
NJ FamilyCare members can call 1-800-701-0170 (TTY: 711) to request another renewal packet. It is important to keep your contact information updated, especially if you have moved in the last three years. This can be done by calling 1-800-701-0710 (TTY: 711).
Medicaid in New Jersey, also known as NJ FamilyCare, expanded in 2014 in accordance with the Affordable Care Act (ACA). This expansion, along with the rule that prevented states from disenrolling anyone from Medicaid between March 2020 and March 2023 due to the pandemic, led to a significant increase in total Medicaid enrollment in the state. As of mid-2023, total Medicaid/CHIP enrollment in New Jersey reached 2.29 million people.
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NJ FamilyCare/Medicaid changes
In New Jersey, individuals who have Medicaid and also purchase private insurance may be able to utilize both types of coverage to maximize their healthcare benefits. This is because, in New Jersey, Medicaid often acts as secondary insurance to private insurance. This means that if you have both types of coverage, Medicaid may cover some costs that your private insurance does not, and vice versa. However, it's important to understand how these two types of insurance coordinate benefits to ensure you're getting the most out of your coverage and to avoid any unexpected costs. Here's some more information about how Medicaid and private insurance can work together in New Jersey:
When both parents have private insurance: If both parents of a child have private insurance through their employers, they may choose which parent's insurance will be primary for the child. The other parent's insurance then becomes secondary. If one parent's insurance is chosen as primary, it does not mean that the other parent's insurance is unnecessary. The secondary insurance may cover some costs that the primary insurance does not, such as copayments or deductibles. In some cases, having two insurances can result in having no out-of-pocket costs for certain services.
Using Medicaid as secondary insurance: In New Jersey, if you or your family members qualify for Medicaid, it can often be used as secondary insurance to your private insurance. This means that Medicaid may cover some of the costs that your private insurance does not, such as copayments, deductibles, or services that your private insurance doesn't cover. For example, if you have private insurance through your employer but still struggle to afford the copayments for prescription medications, having Medicaid as secondary insurance can help cover those costs.
Understanding coordination of benefits: The coordination of benefits is a set of rules that determines which insurance pays first when a person has multiple types of health coverage. In most cases, the insurance that you have yourself (through your employer or purchased privately) will be primary, while Medicaid will be secondary. This means that your private insurance will pay for covered services first, and then Medicaid will step in to cover any remaining costs or services that your private insurance doesn't cover.
Knowing your coverage and costs: It's important to understand the specifics of both your private insurance and Medicaid coverage, including deductibles, copayments, and covered services. Review the benefits of each carefully to know exactly what is covered and what you may need to pay out of pocket. This will help you maximize your benefits and avoid unexpected costs. Additionally, be aware that some doctors or healthcare providers may not accept Medicaid or certain types of private insurance. Always check with your providers to ensure that they accept your insurance plans before receiving services.
By understanding how private insurance and Medicaid can work together in New Jersey, individuals and families can maximize their healthcare benefits and ensure they are getting the coverage they need. It's important to stay informed about any changes to your insurance coverage and to regularly review your options to ensure you're getting the most out of your healthcare benefits.
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Frequently asked questions
Yes, you can use private insurance alongside NJ Medicaid. NJ Medicaid, also known as NJ FamilyCare, is a federal program that provides health insurance to those who meet certain criteria.
Eligibility for NJ Medicaid is based on income and family size. Adults under 65 with incomes up to 138% of the poverty line, pregnant women with incomes up to 200% of the poverty line, and children regardless of their family's immigration status, are all eligible for NJ Medicaid.
Enrollment in NJ Medicaid is available year-round through NJ FamilyCare or GetCoveredNJ, the state-run health insurance marketplace. You can apply online or download a paper application from the NJ FamilyCare website.
If you no longer qualify for coverage through NJ Medicaid, you may be referred to GetCoveredNJ, where you can find affordable healthcare coverage options. You may also qualify for help with premiums, co-pays, and deductibles through New Jersey's Medicare Savings Programs.
