Reproductive Health Care Coverage Options (2024)

NJ FamilyCare is the name for Medicaid and the Children’s Health Insurance Program (CHIP) in New Jersey. As part of comprehensive health care coverage, NJ FamilyCare covers:

• Contraceptive services (including dispensing of up to a 12-month supply of birth control at one time)
• Pregnancy-related care
• Abortion care services
• Preventative health and well-woman care

Pregnant NJ FamilyCare members are guaranteed coverage throughout the pregnancy and for 12 months postpartum (after delivery or the date the pregnancy ends). They will stay covered even if the family’s income changes during that time. After their postpartum period, they will have to renew to see if they still qualify for NJ FamilyCare.

People are encouraged to apply at any time – NJ FamilyCare does not have an open enrollment period.

If you havequestions about NJ FamilyCare, including your benefits, please call NJ FamilyCare at1-800-701-0710(TTY: 711).

Most NJ FamilyCare members are enrolled in a managed care organization (MCO) that coordinates their health care needs. Contact the Member Services of your MCO.

Call your County Medical Assistance Customer Center (MACC) for other questions about NJ FamilyCare.

There are other health care coverage programs for pregnant individuals who do not qualify for NJ FamilyCare:

• Medical Emergency Payment Programcovers emergency services, including labor and delivery, for New Jersey residents age 19 and older who do not qualify for NJ FamilyCare because they do not meet the U.S. citizenship or immigration requirement.
• NJ Supplemental Prenatal and Contraceptive Program (NJSPCP)covers prenatal (pregnancy), doula services, and contraceptive (family planning) care in clinics, hospitals, Federally Qualified Health Centers, and family planning centers. Must meet NJ FamilyCare guidelines except for U.S. Citizenship or immigration requirement.
• Plan First is a limited benefit program, which provides family planning services only. This is for people who are ineligible for NJFamilyCare due to income.

To sign up for health insurance, visit GetCovered.NJ.Gov, the State’s official health insurance marketplace where you can compare plans and see if you qualify for financial help.Many can find a plan for $10 a month or less and 9 in 10 enrollees qualify for financial help. If you qualify, you may be able to get free or low-cost health insurance through NJ FamilyCare (Medicaid). Generally, you can only enroll in a marketplace plan during the open enrollment periods (November 1 through January 31); however, you can enroll at any time if you experience a life-changing event like becoming pregnant or if you meet certain income levels.

If you have questions or need help enrolling, call 1-833-677-1010 (TTY 711).Specially trained navigators are also available to help guide you through the application process and find the right plan for you either in-person or remotely. Find free, local assistance near you.

TheNew Jersey Department of Banking and Insurancestarted requiring coverage for abortion services without exceptions beginning with the 2023 plan year. This began for the Individual Health Coverage Program and the Small Employer Health Benefits Program for plans issued or renewed beginning January 1, 2023 and for the fully-insured large employer health insurance market for plans issued or renewed beginning September 18, 2023.

Insurance coverage for contraception is guaranteed under P.L.2021, c.376 for state-regulated plans including from:

• Group health insurers that provide hospital or medical expense benefits
• Health maintenance organizations
• Individual health benefits plans
• Small employer health benefits plans
• Prepaid prescription service organizations

Coverage for these state-regulated plans must include, at least on an in-network basis:

• Expenses to purchase prescription female contraceptives as approved by the United States Food and Drug Administration (U.S. FDA) without a deductible (except for high-deductible plans in respect to male contraceptives and sterilization), coinsurance, copayment, or other cost sharing based on the individual’s choice of contraception and medical necessity as determined by their healthcare provider
• Either the requested contraceptive drug, device, or product or a therapeutic equivalent
• Over-the-counter (OTC), no-prescription needed for all contraceptive drugs approved for OTC by the U.S. FDA
• Voluntary male and female sterilization
• Patient education and counseling on contraception
• Related administration and monitoring services like side effect management, counseling about the family planning regimen, device insertion and removal, and diagnostic and treatment services
• Dispensing up to 12 months of contraceptives at one time

If you are enrolled in the State Health Benefits Program or the School Employees Health Benefits Program, comprehensive reproductive care, including abortion coverage, is also provided as part of your plan.

Coverage for these State-contracted plans must include, at least on an in-network basis:

• Expenses to purchase prescription female contraceptives as approved by the United States Food and Drug Administration (U.S. FDA) without a deductible (except for high-deductible plans in respect to male contraceptives and sterilization), coinsurance, copayment, or other cost sharing based on the individual’s choice of contraception and medical necessity as determined by their healthcare provider
• Either the requested contraceptive drug, device, or product or a therapeutic equivalent
• Over-the-counter (OTC), no-prescription needed for all contraceptive drugs approved for OTC by the U.S. FDA
• Voluntary male and female sterilization
• Patient education and counseling on contraception
• Related administration and monitoring services like side effect management, counseling about the family planning regimen, device insertion and removal, and diagnostic and treatment services
• Dispensing up to 12 months of contraceptives at one time

For detailed explanation of plan coverage for SHBP/SEHBP, members should refer to the plans’ guidebooks, which are available online: https://www.nj.gov/treasury/pensions/member-guidebooks.shtml

Many private health plans in New Jersey cover reproductive health care services including abortion services in New Jersey. If you are unsure if your plan covers abortion services, contact your insurer.

Under the Affordable Care Act, most health plans are required to provide you with birth control and family planning counseling with no out-of-pocket costs. This includes:

• Hormonal methods, like birth control pills and vagin*l rings
• Implanted devices, like intrauterine devices (IUDs)
• Emergency contraception, like Plan B® and ella®
• Barrier methods, like diaphragms and sponges
• Patient education and counseling
• Sterilization procedures

To learn more about birth control coverage requirements for different types of health plans, visithere.

Beyond the services covered through insurance, there are a variety of state and non-state programs that may be able to provide care or practical support regardless of ability to pay. Practical support may include direct assistance to enable a person to obtain services, such as ground and air transportation, gas money, lodging, meals, child care, translation services, doula support, and assistance related to shipping and handling of medications related to care.

New Jersey’s state family planning program is a network of reproductive health care clinics that provide affordable and confidential care, regardless of the person’s insurance status, residency or immigration status, or ability to pay. To find a clinic nearby: Find a Health Center - New Jersey Family Planning League.

The New Jersey Abortion Access Fund can help New Jerseyans who needhelp with abortion care.

The National Network of Abortion Funds providesfinancial support for people in need of abortion services.