When it comes to family health coverage, New Jersey and Pennsylvania offer distinct choices. Both states operate under the framework of the Affordable Care Act (ACA), providing access to federally facilitated marketplaces and Medicaid expansions. However, key differences in premium costs, provider networks, state programs, and additional family-friendly benefits can influence which state might offer the better value for families.
In this guide, we’ll break down how New Jersey health insurance plans compare to Pennsylvania health insurance options for families in 2025, helping you decide which state may provide the most comprehensive and affordable coverage.
1. Overview of New Jersey Health Insurance
New Jersey operates its own state-based exchange, GetCoveredNJ, which offers families ACA-compliant plans along with state-funded subsidies that can further reduce premiums and out-of-pocket costs.
Key Features:
- State-Based Marketplace (Get Covered NJ):
Families in New Jersey enroll through the state’s exchange, which provides unique state-funded subsidies in addition to federal premium tax credits.
- Children’s Coverage (NJ Family Care):
NJ Family Care covers low-income children and parents who may not qualify for traditional Medicaid. It also ensures coverage continuity for families experiencing income changes.
- State Mandate & Penalty:
New Jersey requires all residents to have health insurance. Families without coverage may face a state-level tax penalty.
- Provider Networks:
New Jersey boasts extensive provider networks, particularly in its urban and suburban areas, making it easier for families to access specialists and pediatric care.
Average Family Premium (2025):
- $1,400/month for a benchmark silver plan (family of four, before subsidies).
2. Overview of Pennsylvania Health Insurance
Pennsylvania uses the federally facilitated exchange Pennie, which is administered by the state to provide access to ACA plans and subsidies. Families in Pennsylvania benefit from Medicaid expansion and a broad selection of private insurance carriers.
Key Features:
- Federally Facilitated Exchange (Pennie):
Families enroll through Pennie, Pennsylvania’s ACA marketplace. Subsidies are federal, with no additional state-funded reductions.
- Children’s Coverage (CHIP in Pennsylvania):
Pennsylvania’s CHIP program is highly regarded and provides free or low-cost coverage to children in families that don’t qualify for Medicaid. It offers comprehensive pediatric services, including dental and vision.
- No State Mandate:
Unlike New Jersey, Pennsylvania does not impose a state-level mandate or penalty for being uninsured.
- Provider Networks:
Urban centers like Philadelphia and Pittsburgh offer extensive provider networks. However, rural areas may have more limited choices compared to New Jersey’s more densely populated regions.
Average Family Premium (2025):
- $1,350/month for a benchmark silver plan (family of four, before subsidies).
3. Key Differences: New Jersey vs Pennsylvania Family Health Plans
| Feature | New Jersey (GetCoveredNJ) | Pennsylvania (Pennie) |
| Marketplace Type | State-based exchange | Federally facilitated exchange |
| Subsidies Available | Federal + state subsidies | Federal subsidies only |
| Children’s Program | NJ FamilyCare (Medicaid and CHIP combined) | Separate CHIP program (free or low-cost) |
| State Individual Mandate | Yes | No |
| Average Family Premium (2025) | ~$1,400/month | ~$1,350/month |
| Provider Network Coverage | Stronger in urban and suburban areas | Varies more in rural regions |
| Penalty for Not Having Coverage | Yes | No |
4. Family-Friendly Benefits in Each State
New Jersey:
- Expanded State Subsidies:
Families earning above the federal subsidy limits (400% FPL) may still qualify for state subsidies, reducing premiums significantly.
- Comprehensive Pediatric Services:
NJ Family Care includes dental and vision benefits for children, along with preventive care and vaccinations.
- Easier Plan Transfers:
When families experience a change in income, switching between NJ FamilyCare and marketplace plans is streamlined.
Pennsylvania:
- CHIP Coverage:
Pennsylvania’s CHIP program offers low-cost or free coverage to children in families that earn too much for Medicaid but still need affordable care. This program includes extensive dental and vision services.
- Lower Premiums on Average:
For similar coverage levels, Pennsylvania families may see slightly lower premiums compared to New Jersey plans, though out-of-pocket costs can vary.
5. Which State Offers Better Family Coverage?
| If You Are… | Best State for You |
| A low-income family needing free or low-cost coverage for kids | Pennsylvania (CHIP program) |
| Looking for subsidies above the federal limits | New Jersey (state-funded subsidies) |
| Living in a rural area needing provider options | Pennsylvania (slightly more rural coverage) |
| Concerned about penalties for going uninsured | New Jersey (state mandate) |
| Seeking comprehensive pediatric dental and vision coverage | Both states offer strong children’s benefits |
Both New Jersey and Pennsylvania provide excellent health insurance options for families. New Jersey’s state-based marketplace, additional subsidies, and integrated Medicaid/CHIP program give it an edge for those seeking extra financial support and simplified enrollment processes. On the other hand, Pennsylvania’s lower premiums, respected CHIP program, and lack of a state mandate may make it more appealing to families prioritizing cost and flexibility.
Ultimately, the choice depends on your family’s income, health needs, and whether you prefer the simplicity of one state’s coverage structure over the other. Be sure to explore all plan options through Get Covered NJ or Pennie to find the best fit for your family in 2025.