Overview of Connecticut’s Health Care Exchange
In 2010, the federal healthcare law—the Affordable Care Act—was passed, giving states the opportunity to build health insurance marketplaces called exchanges. Access Health CT is Connecticut’s exchange. It offers plans from three health insurance providers: Anthem Blue Cross and Blue Shield of Connecticut, ConnectiCare, and HealthyCT.
As of October 1, 2013, you can begin shopping for a healthcare plan. Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
There are a range of different customer support options: registering on the website, talking on the phone to a call center, the navigator in-person assister program, and registering with a health insurance broker. Navigators and licensed brokers must be trained and certified in order to facilitate enrollment. You are able to search for navigators or brokers according to your location.
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
There are three basic plans available, with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), and Gold (80 percent). Lower plans have lower premiums but higher out-of-pocket costs. There is also a catastrophic plan with a high deductible available for folks under the age of 30.
Costs vary among Connecticut counties. For a 30-year-old non-smoker with no income subsidies, a mid-level Silver plan will cost about $280-320 per month in Hartford and $340-385 per month in Fairfield.
Parents living at or below 196 percent of the federal poverty level (also known as FPL, which is $11,490/year in wages for one person and $23,550/year in wages for a family of four), any adults living at or below 133 percent of the FPL, or pregnant women living at or below 258 perfect of the FPL can qualify for Medicaid in Connecticut, based on eligibility standards effective January 1, 2014.
Tax credits are based on the Silver Plans, so individuals can easily determine what their additional out-of-pocket costs will be if they elect a higher or lower plan compared to the Silver Plans. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
The average monthly cost of a Silver Plan for an unsubsidized individual 30-year-old non-smoker in Hartford is $296.95, as of November 1, 2013.
Individuals and families with incomes between 133 percent and 400 percent of the federal poverty level and who are covered by an exchange plan are eligible for tax credits against the cost of their health care coverage. The payment of credits will begin in 2014.
Many people want to know how much of a subsidy they qualify for, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your wages, which would be $2,926 annually, or $244 monthly. The challenge is to examine the costs of Bronze, Silver, and Gold plans to decide which offers the best value for you. Here is a calculator offered by the Kaiser Family Foundation that provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
Subsidies are available for those who qualify. Enter your financial information on the application here, and during the application process you’ll find out your level of eligibility for assistance.
Starting in 2015, there will be additional federal financial protection that includes a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. This financial protection will dramatically reduce the chance of bankruptcy due to medical bills not covered by insurance.