Choosing health insurance should not feel like a second job. Whether you are self-employed, between jobs, or your family has outgrown its old plan, DGS Benefits will compare your options, explain what the numbers actually mean, and help you enroll. We have been doing this for New Jersey families for 35 years.
How individual and family health insurance works
You pay a monthly premium to keep your coverage active. When you need care, you may also pay a deductible (what you pay before the plan starts sharing costs), copays (flat fees for visits and prescriptions), and coinsurance (a percentage of a bill). Every plan has an out-of-pocket maximum, which is the most you can be asked to pay in covered, in-network care during the year. Plans also use networks, so it matters which doctors and hospitals you can see.
Plans are grouped into metal levels such as Bronze, Silver, and Gold. In general, lower monthly premiums come with higher deductibles, and higher premiums come with lower costs when you get care. The right pick depends on how often you use care and how much risk you are comfortable with. We will help you run that math for your own family.
Who needs an individual health plan?
- People whose job does not offer coverage, including the self-employed and freelancers
- People who lost job-based coverage
- Young adults who have aged off a parent's plan at 26
- Early retirees who are not yet 65 and eligible for Medicare
- Families whose current plan has gotten too expensive or no longer includes their doctors
Health plans sold to individuals cannot turn you down or charge you more because of a pre-existing condition. That protection is part of the federal Affordable Care Act. Turning 65? Look at Medicare Supplement plans instead.
Where do you buy an individual health plan?
Most New Jersey residents buy an individual or family plan through Get Covered New Jersey, the state's official marketplace, where you can also apply for financial help. Our page on the NJ Health Insurance Marketplace explains the enrollment dates, how much help is available, and how we can help you enroll.
What affects the price?
Your price depends on your plan, your county, your age, and your household income. Many households qualify for financial help that lowers the monthly premium, and New Jersey adds state help on top of the federal tax credits for some. Do not assume you earn too much to get help. We will run your actual numbers at no charge.
When can you enroll?
Most people enroll during the yearly open enrollment period, which runs November 1 through January 31 on Get Covered New Jersey. Outside that window, you can usually still enroll if you have a qualifying life event, such as losing other coverage, getting married, having a baby, or moving. New Jersey also treats pregnancy as a qualifying event. These special windows are short, so call us as soon as something changes. If you just lost coverage, read Lost Your Health Insurance in NJ? Here's What to Do Next.
Frequently asked questions
Do I need a broker to enroll on Get Covered NJ?
No, but it helps. Enrolling yourself works, but a state-licensed broker can compare plans, check your doctors and prescriptions against each plan, and make sure you claim every dollar of financial help you qualify for.
Can I keep my doctor?
Only if your doctor is in the plan's network. Tell us who you see and which medications you take, and we will check before you choose.
Can I be denied coverage for a pre-existing condition?
No. Individual health plans cannot deny you or charge more because of your health history.
I missed open enrollment. What now?
You may still qualify for a special enrollment period if your situation changed. If not, we can talk about short-term options and what to do before the next window.
Can you also cover my employees or my business?
Yes. Ask us about Employee Benefits for group health plans.
What if a claim is denied?
You have appeal rights. See our page on insurance claims help in NJ.
Is a consultation really free?
Your first consultation is free. Contact us to get started.
DGS Benefits Inc. is a licensed insurance broker in the State of New Jersey and is not a government agency.
Plans, premiums, provider networks, and financial help vary by insurance company, county, age, and household income, and eligibility for financial help is determined by the marketplace.
We do not offer every plan available in your area. Enrollment dates, premium figures, and program rules are subject to change.