ACA Marketplace
The ACA Marketplace (Affordable Care Act Marketplace) is a government-run insurance exchange established under the healthcare reform law. It is a system where individuals can compare and purchase private health insurance and receive government subsidies based on their income. One of its core purposes is to help those whose income is too high to qualify for Medicaid yet low enough to need assistance, enroll in health insurance at affordable premiums through government subsidies.
Key Features (2026)
- Subsidy Benefits (Premium Tax Credits): If your household income is between 138% and 400% of the Federal Poverty Level (FPL), you are eligible for the federal APTC (Advance Premium Tax Credit). If your income exceeds 400% of the FPL, you will not be eligible for federal subsidies, and only the New Jersey State subsidy (NJHPS) will be available.
- Pre-existing Condition Coverage: Insurance companies cannot deny coverage or charge higher premiums just because you have a pre-existing condition (such as cancer or diabetes).
- 10 Essential Health Benefits: Emergency services, hospitalization, pregnancy and maternity care, mental health services, and prescription drugs must be included.
- Dependent Coverage: Children can remain on their parents’ health insurance plan until the age of 26.
Health Plan Levels
Plans are divided into four categories based on how you and your plan share costs.
Subsidy Benefit Guide (2026 plan year; 2025 FPL basis)
- Federal Marketplace Subsidy (APTC): The previous year’s (2025) FPL guidelines are used to calculate subsidies. (The 400% FPL ceiling is $62,600 for a 1-person household and $128,600 for a 4-person household.)
- NJ State Subsidy (NJHPS): A separate benefit provided by the state of New Jersey (NJ Health Plan Savings). By applying through GetCoveredNJ, applicants with incomes up to 600% FPL can receive additional financial assistance.
- Eligibility Verification: The figures provided in this document are for reference purposes only. Final eligibility and benefit amounts are subject to the official determination results from GetCoveredNJ or the NJ FamilyCare website. *Starting in 2026, individuals with incomes exceeding 400% FPL are no longer eligible for federal subsidies (APTC) and can only receive NJ state subsidies.
Enrollment Periods
- Open Enrollment Period: Because New Jersey operates its own state-based marketplace (GetCoveredNJ) rather than using the federal marketplace (HealthCare.gov), it offers a longer enrollment deadline.
- Dates: November 1 – January 31
- Enroll by December 31 for January 1 start
- Enroll by January 31 for February start
- Special Enrollment Period: If certain changes (Qualifying Life Events) occur, you can enroll within 60 days even outside the regular period:
- Marriage or Divorce
- Birth or Adoption of a child
- Relocation (Moving to a different state, etc.)
- Loss of existing employer-sponsored insurance
How To Apply
- Documents Needed for Application
- Social Security Numbers (SSN) for all household members or immigration documents (Green card, etc.)
- Proof of household income (Tax returns, pay stubs, etc.)
- Residential address information
- Federal Marketplace
- Online Application: HealthCare.gov – Texas, Florida, Georgia, and approx. 30 other states.
- Phone Application: 1-800-318-2596 (24/7, Korean interpretation available)
- State-Based Marketplaces:
- Professional Assistance: local Navigators or certified agents can help at no cost.
Contact
- AWCA can provide counseling free of charge (201-862-1665 / info@awcanj.org).
Resources
