The Connecticut Health Insurance Exchange (Access Health Ct) began offering medical coverage to residents of the state beginning in October of 2013. 2016 Open Enrollment starts on November 1st (2015) and pre-existing conditions will continue to be covered without any extra surcharge or increase in deductible or copay. Affordable plans for individuals, families and small business owners are available and the state operates the website instead of the federal government.
Consumers who enrolled last year and still have active policies, can “auto-renew” the policy, which allows you to keep the same plan without repurchasing or re-applying for another policy. Your 2014 plan will automatically convert to 2015 coverage without any forms to fill out or persons to call.
Auto-Renewal Not Always The Best Option
Important: If there was a substantial change in income, your federal subsidy will likely change, and comparing multiple new options is advised. Depending on your specific circumstances, a small increase in household income could result in a premium increase of thousands of dollars per year. If you become ineligible for a subsidy, to keep premiums affordable, you may want to change tiers…For example, from Gold to Silver, or Silver to Bronze.
Also, if you turned age 65 and are now eligible for Medicare, automatically renewing a policy is not an option. Medicare has separate enrollment dates and a Medigap or Advantage plan can be considered to reduce out-of-pocket expenses.
Currently, names of uninsured persons are being collected at town-meetings across the state. Presumably, they will be contacted sometime in the future. New Haven and Bridgeport are two cities that have been given special attention since they have a higher than expected percentage of persons that are without coverage. Also, advertising will probably be noticed on television, radio and billboards. Feel free to view quotes here if you would like an early start.
Our website will continue to provide unbiased guidance and the lowest direct prices available from any carrier. We will guide you through the process, assist with online applications and research and compare the best policies for your unique needs. After you request a quote, within a very short period of time, you’ll be able to see specific options designed just for your situation. Simplifying the enrollment process will help you save time and money.
What Changes In 2015 And 2016?
Actually many things, but we’ll focus on the most important ones. The Affordable Care Act (also known as Obamacare) has changed the way consumers in Connecticut purchase their health insurance. The only underwriting criteria is now where you live, your age and your smoking status. Applicants will not have to complete a physical or provide detailed medical records. And you can’t be denied because of a medical condition.
Many “essential benefits” that were often not included in plans, are now covered. Some of these mandated benefits include maternity, mental illness and birth control. Of course, the common coverages will still be included such as office visits, prescriptions and ER/hospital charges. Preventive benefits will continue to be included without a waiting period, copay or coinsurance.
Additional benefits for women will go far beyond typical maternity services. For example, gestational diabetes screening will be included if it is determined there is a high risk. Counseling on sexually-transmitted infections for sexually active women will also be an unexpected included benefit along with breastfeeding counseling and support and supplies.
Which Carriers Will Participate in Access Health Ct?
Currently, Anthem, HealthyCT and Connecticare are the companies that offer plans inside and outside of the Marketplace. However, Cigna, a major carrier, has already stated it will not be participating in offering individual or group policies to the more than 200,000 persons that are anticipated to apply for coverage. They can request to return in 2016 since there is a mandatory 24-month period of non-participation. About 3,000 consumers will also be eligible for expanded Medicaid benefits.
UnitedHealthcare had also decided NOT to offer coverage in 2014, which was a bit of a surprise. They market their plans under the “Golden Rule” name and don’t write a substantial amount of business in the state. They also indicated that they would only participate in 10-15 State Marketplaces in 2014. But they are offering plans for 2015 effective dates.
HealthyCT (formed by the state Medical Society) was the first company to formally request their rates for small group and individual policies. The average monthly premium for individual coverage is approximately $430 and $445 for small groups. But the maximum prices rise above $1300 for both categories. This insurer utilized a consulting company to help determine the prices it would charge since they had no figures to use from last year.
Recently, HealthyCT, which is a non-profit company, reduced its proposed rates by about 36%, which is a very significant change. CEO Kevin Counihan mentioned that the high competition from other companies was the reason for the decrease.
Harvard Pilgrim is a newer player in the Marketplace. They are now a licensed carrier in the state. Approved by regulators, this non-profit Massachusetts-based company already has more than one million customers. Most of their anticipated business is centered in the New England area and plan availability started in 2014.
It is anticipated that policies will be ready for the 2016 Access Health Ct. Exchange, according to CEO Eric H. Schultz, who is a UCONN graduate. With a strong local network and a great track record, Harvard Pilgrim could become a very popular choice for consumers.
What About Tax Credits To Help Pay My Premium?
It is highly possible that you will qualify for a subsidy that could potentially lower your rate. And perhaps quite a bit. The formula is based on your household adjusted gross income (AGI). For instance, if your household income is $55,000 and you are married with two children, a government tax credit of approximately $6,000 will be awarded. However, if your income increases to $70,000, the credit reduces to $3,500.
For single persons, the amounts are much lower. For example, a 30-year old who makes $25,000 per year, will receive a subsidy assistance of about $1,700. An income of $37,000 will completely eliminate the tax credit. At those income levels, considering purchasing a policy outside of the Exchange should be strongly considered.
Business owners will also receive help. Here are a few scenarios: Let’s suppose you own a business with 10 employees whose average income is $30,000. If you typically pay $250 per month towards their health insurance premiums, your annual tax credit will be $12,000. However, if you have five employees, their average income is $40,000 and you pay about $400 per month towards their premiums, you will not receive a credit. Naturally, these numbers are estimates but should be very accurate.
HSA rates in Connecticut are also expected to remain attractive for both private an business use. Tax incentives are still in place and the plans continue to be a focal point in finding low cost policies.
If your business meets specific qualifications (such as 2-50 employees and average wage less than $50,000), the amount of tax subsidy could be as much as 50%. Of course, you must pay at least half of your worker’s premiums. There are other factors and we’ll be happy to review them with you.
What’s The Latest News?
The CEO of Access Health Connecticut, Kevin Counihan recently spoke to Tom Harkin, the chairman of the US Senate, Health, Education, Labor and Pension Committee. Counihan reiterated that he would like wider availability of medical coverage and and easy shopping and purchase process. He also talked about a “Risk Adjustment Program” that works to stabilize low-risk and high-risk applicants.
Also, there will be some stores in selected locations to help consumers, especially those without internet access and/or a home computer. Anticipated locations are New Haven, Waterbury, Hartford and New Britain. A total of six stores are planned to be constructed and finished in 2013.
If they resemble an “Apple Computer” store, it’s not a coincidence. A staff of workers and possibly brokers will attempt to assist consumers with understanding individual and small business plans. Videos will also be available.
Free events to the public are also helping to spread some of the new Exchange information to residents. Two meetings were already scheduled in New Britain and Waterbury to review some of the legislation changes and how it impacts residents. Of course, our own website regularly updates and publishes any new information that we receive.
There is also now a call-center that has almost 50 employees waiting to help. They can answer basic questions regarding the Exchange and certain aspects of the legislation. The building is located in downtown Hartford.
Also, payment deadlines are being extended by many of the participating insurers. ConnecticutCare Benefits and Anthem ae two carriers that are giving consumers more time to pay. One of the reasons is that after enrolling for coverage, often the actual bill is not received or sent until after the effective date. Pharmacies, such as CVS, are also trying to be as accommodating as possible to all of the new customers.
On 9-27-2013 it was reported that Connecticut prices will be higher than all but three other states. Of course, with the fourth highest healthcare costs in the US, perhaps we shouldn’t be surprised. Another reason for the high pricing is the number of mandatory benefits that state residents must pay for, regardless if they want or need them. In the summer of 2014 it was reported that prices would increase (for 2015) for some carriers, and decrease for others.
The least expensive policy is projected to cost about $350 per month. However, a “Silver” policy may cost about $100 more, which is significantly higher than many other states.
Will There Be Out-Of-Pocket-Maximum Costs?
Yes. All of the plans will be capped at $6,350 for single coverage and $12,700 for families, regardless of size. There are self-funded contracts through a few employers that could have separate deductibles to meet for regular coverage, mental or behavioral, and drugs. This “triple whammy” could conceivably triple the potential maximum liability for consumers.
But this triple treat will not apply to policies purchased through the Marketplace. The US Department of Labor also explained that a 12-month grace period given to employers (to avoid the penalty for not providing coverage) could impact companies that have separate policies through insurers providing different benefits.
How Do I See Rates And/Or Apply For Coverage?
Our website will provide current prices from all of the major companies along with multiple application options. We can also help determine your federal tax subsidy and how much it will reduce your rates. Simply provide your zip code where requested (near top of the page) and you will be able to view affordable options.
How Are Future Prices Determined?
Each year, carriers that wish to participate, must file their proposed rates with the Department Of Insurance. Typically, this occurs in May or June. Of course, the larger the requested increase, the more scrutiny and attention will be given to the justification of the new proposed prices.
For example, Anthem Blue Cross and Blue Shield was attempting to raise prices an average of 12% for 2015-issued policies. On Friday June 27th (2014), a hearing was held and the public was invited. Questions could also be submitted by anyone not able to attend the meeting.
October 2013 – A recent federal data outage, (from the national healthcare.gov website) has made it difficult for visitors to finish the application process. New accounts can be created and prices of different plans can still be viewed. The delay is expected to be temporary and should be fixed quickly.
November 2013 – Demographics information was released, and it shows that most applicants are age 45 and above. Young healthy persons are still badly needed and it is expected that from Thanksgiving through the middle of December, traffic will surge on Exchanges and websites like ours.
December 2013 – Glitches and inaccuracies on the Access Health CT website were found in October and applicants have been notified. A combination of phone calls and postings on the site itself have kept consumers alerted and updated regarding potential errors.
Policy coverage information was accurate. However, rates posted for various plans from three specific insurers were not correct. The State Insurance Department was notified and prices were quickly corrected. More than 2000 letters were sent out to potential customers that may have been impacted.
December 2013 - More than 50,000 persons have enrolled for Jan 1 effective dates. The extended deadline ended yesterday, so new policies will be issued with a February 1 effective date. We still highly recommend considering “Silver” plans if you are eligible for a subsidy. The “cost-saving” features will be a bog money-saver.
March 2013 – Connecticut’s rates are the fourth-highest of all states in the US, according to a study by the White House that was released last week. Possible reasons are the lower number of carriers offering plans (New York has more than 15 companies on Exchange), and the higher cost of medical care and procedures in the state. Also, in many other states, rates are better-negotiated with insurers, and often, lower premiums are a result.
In fairness, most state plans contain more benefits than other states, including nearby New York and New Jersey. And other areas have smaller and less-extensive provider networks, which often reduces prices.
March 2014 – The CT health insurance market is not nearly as competitive as it was a few years ago, according to the Henry J. Kaiser Family Foundation. In their study, they point out that only three carriers are available to consumers in 2014, compared to five in 2012. Giants UnitedHealthcare and Aetna are currently not participating in the Exchange, although they could offer plans next year. Additional reports are available online through the government website.
May 2014 - The Connecticut Mirror released findings from their investigation into Aetna’s profits for the last six years. The information was largely acquired through a Freedom of Information request. It was pointed out that Aetna has never had a price increase rejected in the last eight years. Anticipated claims never materialized, which is why profits were a bit higher than expected.
June 2014 – The missing backpack saga that was full of personal information from CT Exchange applicants has come to a conclusion. Maximus, the company who employed the person that left the backpack at a local deli, is now making changes to ensure it will not happen again.
An investigation revealed that the employee violated company regulations and now better understands the importance of consumer privacy. The backpack was eventually found and returned, with no missing data.
July 2014 – About 6,000 of residents will be contacted this week regarding an inaccurate tax credit calculation that can result in the wrong rates. Some of the resulting issues included receiving larger than expected bills, incorrect Medicaid eligibility notifications and cancellation notices.
All of the impacted persons had requested a change to their coverage, either during or after the enrollment process. Applicants who were incorrectly canceled, will be reinstated with all covered claims paid. However, it appears that nobody had their policy terminated because of an incorrect subsidy calculation.
October 2014 – Aetna and UnitedHealthcare were notified by the Department of Insurance that their proposed rate increases were not approved. Aetna’s request for a 9.4% price hike was disallowed, and instead an increase of half the amount was provided. UnitedHealthcare’s off-Exchange plan proposal had its price also reduced by about 9%.
ConnectiCare would like to increase rates by about 13% on POS plans issued in 2010 and earlier (grandfathered policies). Any person that owns these contracts can also change to a different plan during Open Enrollment, although a comprehensive comparison of cost and benefits should be done first.
May 2015 – Assessments (fees) for private and small group policies in 2016 may be increasing. The proposed increase in premium is separate from any actual rate hikes the insurers may request. These fees are directly used to fund the State Exchange (Access Health CT).
The Department of Social Services also contributes funds to pay operating expenses. Unlike most other states that do not rely on the federal government to operate their Marketplace, Connecticut is in relatively good financial shape, and is well-positioned to adjust to the future loss of federal funding.
July 2015 – CT Medicaid eligibility requirements have changed, and more than 1,000 persons will need to switch to Exchange plans. Because income levels are now lower, more persons will have to enroll in private medical plans instead of state or federally-sponsored coverage.
However, the State Department of Social Services (DSS) said that lower-income adults without qualified dependents should not be impacted. Parents of children enrolled in HUSKY notice a change since the Federal Poverty Level (FPL) ratio now used will be 155% instead of 201%. DSS will notify by mail all families that are affected.