Get Covered New Jersey marketplace plans and ADHD coverage

If you buy your own health insurance in New Jersey, you can buy it through Get Covered New Jersey, the state's official marketplace, or directly from an insurer. Every plan sold there covers mental health care, and New Jersey's parity law applies to it. The real choices for someone with ADHD are about cost: which metal level, how much the deductible will matter for regular follow-up visits and prescriptions, and how much financial help you can get. Open enrollment for the 2027 plan year runs from November 1, 2026 to January 31, 2027.

How Dr. Shershow's practice works with marketplace plans is a question for the office. Call to ask, or see the fees and insurance page.

Key dates for the 2027 plan year

New Jersey kept a three-month window on purpose. The Department of Banking and Insurance (DOBI) explains in Bulletin 26-07 that N.J.S.A. 17B:27A-6.1 requires an individual market open enrollment period of at least 90 days. A 2025 federal rule would have shortened it, but a federal court decision in June 2026 blocked those limits, so the state's 90-day minimum remains in effect.

What every plan covers for ADHD

Each plan sold on Get Covered New Jersey covers the essential health benefits, and the list includes mental health and substance use disorder services. HealthCare.gov adds that marketplace plans must provide parity protections, meaning limits on mental health care cannot be more restrictive than limits on medical and surgical care, and that plans cannot deny coverage or charge more because of a pre-existing condition. An ADHD diagnosis cannot be used against you when you enroll.

New Jersey adds its own protections. P.L.2019, c.58 applies directly to individual health insurers and individual health benefits plans in the state. It defines mental health conditions as any condition in the DSM, which includes ADHD, and requires coverage under the same terms and conditions as other illnesses. That law, and how it compares with employer plans, is explained in does insurance cover adult ADHD care in New Jersey.

Financial help: federal credits and NJ Health Plan Savings

Two kinds of help lower premiums for people who enroll through Get Covered New Jersey.

• Federal premium tax credits. The enhanced federal credits that had been available expired on December 31, 2025, according to Get Covered New Jersey. For 2026, people with income over 400 percent of the federal poverty level are not eligible for federal premium help. In its August 2026 release, DOBI said the failure to extend the enhanced credits raised premiums starting in 2026.
• NJ Health Plan Savings. This is New Jersey's own subsidy, and Get Covered New Jersey says it is the only place to apply for financial help. DOBI says it remains available for 2027 to qualifying residents with household income up to 600 percent of the federal poverty level. For 2026, that meant an individual earning up to $93,900 or a family of four earning up to $192,900 could qualify. The 2027 dollar limits were not yet published by DOBI when this was written.

DOBI has also said New Jersey will see rate increases for 2027, driven by medical and drug costs and the loss of the enhanced federal subsidies. Enrollment fell from the end of open enrollment to 434,700 people as of June 30, 2026. Compare your actual 2027 price after help, not last year's, before you renew.

If your income is at or below 138 percent of the poverty level, you may qualify for NJ FamilyCare instead, which you can join at any time of year. See NJ FamilyCare and adult ADHD.

Metal levels and ongoing ADHD care

Marketplace plans come in metal categories: Bronze, Silver, Gold and Platinum. Get Covered New Jersey's FAQ says no Platinum plans are currently offered in the marketplace. According to the same FAQ, Bronze plans have the lowest premiums and the highest cost-sharing, Gold plans pay about 80 percent of costs, and Silver plans pay about 70 percent. Silver is the only metal level eligible for cost-sharing reductions, which lower out-of-pocket costs for people who qualify.

ADHD care is usually ongoing rather than a one-time cost. If you start medication, you can expect an evaluation, more frequent follow-up visits at first, and then visits at regular intervals, plus a prescription filled every month. Think through the year, not one visit.

DOBI noted in January 2026 that reduced federal help pushed more residents toward lower-cost Bronze plans. A Bronze plan can still make sense, but run the numbers for a year of visits and monthly prescriptions first.

Checklist before you choose a 2027 plan

1. Search each plan's directory for adult psychiatrists or psychiatric nurse practitioners near you, or who offer video visits to patients located in New Jersey.
2. Look up your ADHD medication on each plan's drug list and note the tier and any prior authorization.
3. Find the cost of a mental health or specialist office visit, and whether it is subject to the deductible.
4. Check out-of-network coverage if you plan to see someone outside the network. See out-of-network reimbursement in New Jersey.
5. Compare the full-year total: premium after help, plus expected visits and prescriptions.
6. Enroll by December 31 if you want coverage from January 1.

For broader ways to reduce medication costs, see ADHD medication costs in New Jersey.

If your plan denies care

Plans sold in New Jersey's individual market are regulated by DOBI. After the plan's internal appeal, you can take a medical necessity denial to the state's Independent Health Care Appeals Program; DOBI says the written request must be filed within four months of the final internal decision. See appealing an insurance denial for ADHD in New Jersey.