2025 Individual Insurance Open Enrollment

	This article is a part of our Health Insurance and Autism Series. Take Me Back To The Insurance Hub

The enrollment period for individual insurance plans is open from November 1 to January 31.

Coverage will start on the first day of the month following your plan selection.

Do you need a health plan that covers your child’s autism treatment? Are you considering changing the plan you currently have?

Upon learning their child is diagnosed with autism and receiving treatment recommendations from their physician, some families discover that medically necessary interventions such as Applied Behavior Analysis (ABA) are not currently covered by their employer health plan.

One option is for families to purchase an individual plan for their child through New Jersey’s health insurance marketplace. Individual insurance plans issued in New Jersey must follow state mandates, including Health Benefits Coverage for Autism and Other Developmental Disabilities, which ensures that individuals with autism can receive medically necessary treatment, such as ABA.

Several insurance companies issue individual plans in New Jersey. While all plans must provide mandated coverage, the amount that families will pay out-of-pocket depends on the type of plan they choose, and whether they qualify for a premium tax credit. Tax credits are determined by income as well as access to employer-sponsored health coverage.

If you qualify for a premium tax credit, you can save money by purchasing a plan on the health insurance marketplace at GetCoveredNJ. Otherwise, you can purchase a plan directly from an insurance company or with the help of an agent.

Not sure if you qualify for a tax credit or what plan you should choose? The New Jersey Department of Banking and Insurance provides a guide for consumers shopping for 2024 individual insurance plans and a table showing monthly rates for available plans.

The guide will help you determine whether to shop for a plan on the marketplace, or directly with an insurance company, and decide what kind of plan to buy based on several considerations such as:

• Do my doctors and other providers participate in the insurer’s network?
• How much I will pay for:
  • Monthly premium
  • Deductible
  • Copayment
  • Coinsurance
  • Prescription drugs
  • Maximum out-of-pocket for the year?

In addition, the guide offers contact information for help choosing plans on and off the marketplace and a list of carriers offering plans in 2025. Note: not all carriers offer plans through Get Covered NJ, but all plans are subject to NJ insurance mandates.

Note: Medicaid/NJ FamilyCare coverage of ABA services for children with autism began April 1, 2020. Here’s how families can get started.

If you have questions about health coverage options and autism, contact Autism New Jersey at 800.4.AUTISM or information@autismnj.org.

General Information Getting Covered	Special Cases Resolving Issues	Medicaid
Introduction to Insurance	Split Application Medicaid	Medicaid and How To Enroll
Self-Funded Plans	Child-Only Plans	Medicaid: Starting Treatment
Fully Insured Plans	In-Network Exceptions	EPSDT Medicaid Benefit
Medicaid and How To Enroll	Prompt Pay Law	Treatment When You Need It
Child-Only Plans	Treatment When You Need It	Medicaid for Adults
	Mental and Behavioral Health Parity Law	Medicaid and ABA: Knowing Your Rights
	Role of an Insurance Regulator
For Professionals		Insurance Hub

Originally posted 12/13/2018
Updated 8/8/2019
Updated 11/6/2020
Updated 11/4/2021
Updated 11/12/2021
Updated 11/14/2022
Updated 11/1/2023
Updated 10/3/2024