Jeffrey Wade
If you have Medicaid and other insurance in New Jersey, you are part of the NJ FamilyCare program. This includes CHIP (Children's Health Insurance Program) and Medicaid. NJ FamilyCare is a publicly funded health insurance program that provides free or low-cost health insurance to qualifying New Jersey residents of any age. Enrollment is available year-round, and eligibility is based on income and household size.
| Characteristics | Values |
|---|---|
| Name of Program | NJ FamilyCare |
| Website | HealthCare.gov, NJ Family Care |
| Phone Number | 1-800-318-2596 |
| Contact Number for Assistance | 1-800-701-0710 |
| Eligibility | Aged, blind, disabled, adults with income up to 138% of poverty level, pregnant women with income up to 200% of poverty level, children with income up to 350% of poverty level |
| Enrollment | Year-round |
| Paper Applications | Available for download on the NJ Family Care website, but online applications are encouraged |
| Renewal | Members should complete and return renewal packets sent by NJ FamilyCare/Medicaid to determine continued eligibility |
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What You'll Learn
NJ FamilyCare eligibility
Medicaid enrollment in New Jersey is handled by NJ FamilyCare or GetCoveredNJ. NJ FamilyCare is the state's Medicaid/CHIP programme. The following groups are eligible for NJ FamilyCare:
- Adults under the age of 65 with incomes up to 138% of the poverty line.
- Pregnant women with incomes up to 200% of the poverty line.
- Children with household incomes up to 350% of the poverty line are eligible for CHIP.
- The aged, blind, and disabled.
You can apply for NJ FamilyCare online at HealthCare.gov, or through the NJ Family Care website or paper application. You can also apply by phone.
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Medicaid enrollment
Medicaid is a federal and state program that helps low-income individuals and families get health care coverage. In New Jersey, Medicaid enrollment is handled by NJ Family Care or GetCoveredNJ, the state-run health insurance marketplace. NJ residents who are eligible for Medicaid include 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 with household incomes up to 350% of the poverty line. The state expanded Medicaid in 2014 to include more people, and as a result, total Medicaid enrollment in New Jersey increased by 78% between 2013 and 2023.
You can apply for Medicaid in New Jersey online at HealthCare.gov or through the NJ Family Care online application. Paper applications can also be downloaded from the NJ Family Care website, although they strongly encourage online applications. Additionally, you can apply by phone at 1-800-318-2596 or contact NJ Family Care for assistance at 1-800-701-0710.
If you meet the eligibility requirements, you can enroll at any time. When applying, make sure you have the following information on hand: proof of income, unemployment benefits, SSI benefits, pensions or retirement, alimony, etc. You will also need to fill out the NJ FamilyCare Plan Selection Form and return it in the envelope provided. If you are assigned to a different health plan during enrollment, you have 90 days to choose another plan. You can also switch plans during the annual open enrollment period from October 1 to November 15 each year or for other reasons, such as losing access to your doctor under your current health plan.
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Dental insurance
Dental care is not usually included in private health plans in the US, but it is offered by government programs like NJ FamilyCare. NJ FamilyCare provides free or low-cost dental coverage to qualifying residents of any age, including uninsured children and pregnant women with income above the eligibility threshold for Medicaid. Adults enrolled in Medicaid in New Jersey are also eligible for extensive dental services through NJ FamilyCare.
Aetna Better Health of New Jersey provides comprehensive dental care as part of its benefits package. You can find a dentist using the LIBERTY Dental Plan Find a Dentist tool, which includes dentists treating children under six and those who treat adults and children with intellectual and developmental disabilities.
Delta Dental of New Jersey offers individual and family dental plans. Their MySmile program provides members with access to savings on hearing aids and services through Delta Dental's hearing savings program with Amplifon Hearing Health Care.
If you have a private insurance plan, it is worth checking whether any dental care is covered. This information can often be found in your Summary of Benefits and Coverage.
There are also various dental discount plans available in New Jersey. These are not insurance but can offer discounted rates at participating dentists.
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Medicare
Medicaid, on the other hand, is a joint federal and state programme designed for people with limited incomes. It assists Americans of all ages in paying for medical and long-term custodial care costs. The eligibility requirements and benefits offered by Medicaid can vary from state to state, as each state runs its own programme while adhering to general guidelines set by the federal government. In New Jersey, the Medicaid programme is called NJ FamilyCare, and it covers the aged, blind, disabled, adults with incomes up to 138% of the poverty line, pregnant women with incomes up to 200% of the poverty line, and children with incomes up to 350% of the poverty line. Children who need low-cost care but whose families earn too much to qualify for Medicaid may be covered by the Children's Health Insurance Program (CHIP).
While Medicare and Medicaid are separate programmes, they can work together for individuals who are eligible for both. Individuals can contact 1-800-MEDICARE or their local Medicaid office to learn more about costs and coverage, especially if they qualify for both programmes.
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Losing coverage
Losing Medicaid coverage in New Jersey
Medicaid coverage in New Jersey is called NJ FamilyCare. In 2023, nearly 130,000 New Jersey residents lost their access to Medicaid between April 1 and August 31. This was due to the federal government restarting eligibility reviews for NJ FamilyCare on April 1, 2023, after a three-year pause.
If you lose your NJ FamilyCare coverage, you will not be automatically enrolled in Get Covered New Jersey, the state's official health insurance marketplace. However, you can apply for coverage through Get Covered New Jersey if you are eligible. You can also find free local assistance and browse plans to see if you qualify for financial help.
New Jersey has expanded its Special Enrollment Period for those who have lost their Medicaid coverage. This expanded period is available to anyone who lost their NJ FamilyCare coverage due to the resumption of eligibility reviews, regardless of when they lost coverage. Previously, individuals only had 120 days to enroll after their coverage ended.
If you lose your Medicaid coverage due to not completing your renewal form, you will need to submit a new application or update an existing application for coverage through Get Covered New Jersey and attest that you have lost coverage.
It is important to note that losing Medicaid coverage can have a significant impact on individuals and families, especially those with low incomes, disabilities, or elderly residents who depend on the program.
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Frequently asked questions
You can apply online at HealthCare.gov or through the NJ Family Care online application. You can also apply by phone at 1-800-318-2596 or contact NJ Family Care for assistance at 1-800-701-0710.
Adults under the age of 65 with incomes up to 138% of the poverty line and pregnant women with incomes up to 200% of the poverty line are eligible for Medicaid in New Jersey. Children with household incomes up to 350% of the poverty line are eligible for the Children's Health Insurance Program (CHIP).
NJ FamilyCare is the name of the Medicaid/CHIP program in New Jersey. It is the state's publicly funded health insurance program that provides coverage for qualifying residents based on income and household size.
"Unwinding" is the process where New Jersey restarts yearly eligibility reviews for everyone enrolled in NJ FamilyCare/Medicaid. This process began on April 1, 2023. During this time, members must complete and return renewal packets to determine if they still qualify for coverage.
If you no longer qualify for coverage through NJ FamilyCare/Medicaid, you may be referred to GetCoveredNJ, the state's official health insurance marketplace. Here, you can shop for and purchase affordable healthcare coverage. You may also qualify for help with premiums, co-pays, and deductibles through New Jersey's Medicare Savings Programs.
