Access Health Ct, the Health Insurance Exchange Marketplace for Connecticut residents, offers affordable medical coverage for individuals and families, regardless of medical conditions. Low-cost federally-subsidized plans are available along with non-Obamacare options that don’t rely on government aid. You can easily review multiple plans from all available companies, and quickly enroll online. Comprehensive, catastrophic, HSA, single, family, and student plans are offered.
Many improvements and changes have been made. More individual plan choices, broader provider networks, and price decreases can benefit consumers. Open Enrollment begins every November 1st, although qualifying life events through special enrollment periods, and short-term coverage are available at any time. Policies with many different deductible and copay options, can be customized to closely match your household budget and health needs. If you are eligible for Medicare or Medicaid, separate plans are offered.
CT Medicare Supplement (Medigap) and Medicare Advantage plans are available for Seniors, although the Open Enrollment period starts earlier (October 15th). Part D prescription drug plans are also offered to persons that have reached age 65 and are Medicare-eligible. Supplement plans are standardized, which helps consumers compare benefits. A special High Deducible option (Plan F) offers a single deductible with lower premiums.
Typically, if you purchase an “off-Exchange” plan, you can expect a robust network of doctors, specialists, hospitals and other medical facilities. However, “on-Exchange” (Marketplace) policies sometimes feature limited availability and a much smaller network. This is a common practice among many major insurers. Therefore, it is important to verify that your physician, specialist, and any other facility you use is considered “in-network.” This can save thousands of dollars of out-of-pocket expenses. Often, if an “X” precedes the name of the plan, the network is utilized for federally-subsidized contracts. Emergency treatment, however, is generally considered “in-network,” regardless where you receive service.
Previously, the “85 Rule” took effect. This requires participating carriers to include at least 85% of their “off-Exchange” providers in policies sold through the Marketplace along with new regulations designed to protect policyholders. Also, new standards were created to protect consumers that have to travel unnecessary long distances for in-network treatment as well as the length of time it takes to provide treatment.
The impact has resulted in higher rates, since companies now have less clout regarding the selection of who is included and excluded in their networks. Previous negotiated huge reductions may become much less, which ultimately impacts the customer’s pocketbook with higher out-of-pocket costs. Fortunately, large network reductions are continue to be applied to many common services, such as MRIs, CAT scans, blood tests, x-rays, outpatient procedures, and Urgent Care visits.
If you forget to sign up or miss Open Enrollment, additional options are provided. SEP (Special Enrollment Periods) provide numerous exceptions that allow you to purchase coverage any time of the year. Access Health CT comparisons provide the information needed to select the best available policy (subsidized or unsubsidized). “Qualifying life events” provide the exceptions needed to enroll. Common examples are moving to a different service area, losing employer-provided benefits, reaching age 26 while covered under a parent’s policy, divorce, or birth of a child (baby will qualify, but not the parents).
Companies Requested 2018 Price Changes
Of course, prices have changed. For most carriers, premiums have increased. Due to higher-than-expected submitted claims in the past, and an increase in future claims and expenses, most companies requested price hikes. Many plans are no longer available, or have been replaced by alternative coverage. Listed below are recent requested rate changes that were submitted to the Connecticut “Department Of Insurance.” These requests include private individual and family coverage, along with Group plans offered through employers.
Aetna – 19.37% Preferred PPO Small Group
Anthem BCBS – 24.16% – HMO Individual
Anthem BCBS – 28.09% – PPO Individual
Anthem BCBS – 38.26% – HMO Off-Exchange Individual
Anthem BCBC – 24.68% – HMO On-Exchange Small Group
Anthem BCBC – 31.81% – PPO Off-Exchange Small Group
Anthem BCBC – 13.35% – HMO Off-Exchange Small Group
ConnectiCare – 11.05% – POS Individual
ConnectiCare – 4.85% – POS Small Group
ConnectiCare – 33.41% – POS Individual
ConnectiCare – 7.99% – FlexPOS Small Group
ConnectiCare – 4.54% – HMO Small Group
ConnectiCare – 29.27% – HMO Individual
Harvard Pilgrim – 10.75% – Small Group
HPHC Insurance – 17.10% – Small Group
Oxford Health – 12.62% – PPO Small Group
Oxford Health – 8.43% – HMO Small Group
Oxford Health – 9.87% – POS Small Group
UnitedHealthcare – -.51% – Choice Plus Small Group
Cigna, one of the largest US carriers, maintains a strong group/employer market share in the state. However, they are offering no options in 2018 and did not participate in 2016 and 2017. Their Senior products, however, continue to be very popular.
Selected estimated monthly plan prices are listed below. Subsidies, which can substantially reduce premiums, are included. Depending upon eligibility and household income, your subsidy could pay most or all of the premium.
25 Year-Old New Haven County With Income Of $26,000
$20 – Choice Bronze Standard POS HSA (ConnectCare) – HSA-eligible option with $5,865 deductible and $6,550 maximum out-of-pocket costs and 10% coinsurance.
$26 – Passage Bronze Alternative PCP POS (ConnectCare) – $6,500 deductible with maximum out-of-pocket expenses of $7,350 and 50% coinsurance. No charge for pcp office visits. $5 generic drug copay ($10 for 90-day mail order).
$32 – Bronze High Deductible HMO Pathway X Enhanced (Anthem) – $6,500 deductible and $7,350 maximum out-of-pocket costs and 40% coinsurance.
$45 – Bronze HMO Pathway X Enhanced for HSA (Anthem) – HSA-eligible option with $5,800 deductible and $6,650 maximum out-of-pocket costs and 30% coinsurance.
45 Year-Old Fairfield County With Income Of $34,000
$109 – Choice Bronze Standard POS HSA (ConnectCare) – HSA-eligible option with $5,865 deductible and $6,550 maximum out-of-pocket costs and 10% coinsurance.
$163 – Choice Bronze Standard POS (ConnectCare) - $40 pcp office visit copay, but specialist visits must meet deductible. $6,000 deductible with $7,150 maximum out-of-pocket expenses and 50% coinsurance.
$171 – Bronze PPO Standard Pathway X (Anthem) – $40 pcp office visit copay with $75 Urgent Care copay. Specialist visits must meet deductible. $6,000 deductible also applies to prescription drugs.
$171 – Bronze HMO Pathway X Enhanced For HSA (Anthem) – HSA-eligible option with $6,250 deductible and $6,550 maximum out-of-pocket costs and 0% coinsurance.
$264 – Choice Silver Standard POS (ConnectCare) – Cheapest Silver-tier plan. $35 and $50 copays on office visits with $75 Urgent Care copay. Deductible is $4,000 with maximum out-of-pocket expenses of $7,150. Copays only for Tier 1, 2, and 3 drugs ($5, $35, and $60).
$332 – Gold HMO Pathway X Enhanced (Anthem) – Least expensive Gold-tier plan. $40 and $50 office visit copays with low $1,500 policy deductible. Maximum out-of-pocket expenses are $4,800. Tier 1 and Tier 2 prescription drug copays are $5 and $60.
50 Year-Old Married Couple Hartford County With Income Of $45,000
$29 – Bronze Select HSA (ConnectiCare) – HSA-eligible with $6,000 deductible (per person).
$140 – Bronze Basic HSA 3 (Healthy CT) – Attractive $4,250 deductible and HSA-eligible.
$187 -Bronze Choice (ConnectCare) - $30 pcp office visit copay with reasonable $3,500 deductible (per person).
$349 – Silver Standard (ConnectCare) – $30 and $50 copys on pcp and specialist visits. $150 prescription deductible with low copays on Tier 1, 2, and 3 drugs ($5, $35, and $55).
$414 – Silver PPO Standard Pathway X (Anthem) – Attractive $2,900 deductible with $30 and $50 office visit copays. Similar prescription benefits as prior plan.
High Deductible Plans (HDHP) with HSAs
HSA plans have been one of the fastest growing types of medical coverage over the last decade. And why not? Rates are typically quite affordable compared to other options, you generate a tax deduction (for dental and vision expenses too) and retain much better control over your expenditures. HSA coverage is most effective for individuals and families that rarely meet their deductible, and have no major illnesses or chronic conditions. You can change companies, while still retaining the same HSA banking agreement. Also, if you reach age 65, although deposits are no longer allowed, approved funds can continue to pay for qualified expenses.
Companies that participate in the CT Marketplace, are required to include a Bronze HSA in their portfolio of products. Additional information are provided to consumers regarding how these plans work and the role of the special side fund. However, the “side fund” is not mandatory to qualify for a High-Deductible plan. Often, it is either never set up, or created months after the original policy was purchased. Banks often administer the HSA portion of the coverage, while insurers underwrite and administer the actual healthcare coverage.
For 2018, the maximum allowed contribution into an HSA is $3,450 for individuals, and $6,900 for a family. A $1,000 “catch-up” contribution is permitted if you have reached age 55. The minimum deductibles are now $1,300 for individuals, and $2,600 for a family. The maximum out-of-pocket amounts for 2018 are $6,650 for individuals and $13,300 for a family.
Listed below are the available Connecticut HSA Plans:
Choice Bronze Standard (ConnectiCare)
Bronze HMO Pathway X Enhanced For HSA (Anthem)
Bronze PPO Standard Pathway X For HSA (Anthem)
Dental Insurance For Adults
Previously, pediatric dental coverage was required, and included on most plans. However, if you wanted adult benefits, you had to purchase it separately through the major companies that offered it. Or, reputable websites, such as www.connecticutdentalinsurance.com were available for free quick quotes and easy enrollment. Actually, you can still purchase coverage through this website and receive the lowest available rates.
Individual and family dental policies are now offered. You can buy a plan at the time you enroll for your healthcare coverage. Or you can visit the website we earlier mentioned. Monthly premiums can range between $20 and $75, depending upon covered benefits. The lower-priced options typically cover preventive benefits only. Root canals, bridge work and other comprehensive procedures are usually covered, but not fully. More comprehensive benefits are offered through employer-provided Group plans.
Listed below are several available individual and family dental plan options from various approved carriers. Monthly rates are shown for a 40 year-old male residing in Hartford. Benefits, and out-of-pocket maximums will vary between companies. Prices can also vary, depending upon the county of residence. Waiting periods may be required on selected major procedures.
$21 – Starmont Preventative Basic 2.0. $1,000 maximum benefit and $50 deductible.
$22 – IHC Group Bay. $1,000 maximum benefit and $50 deductible.
$26 – Nationwide Multiflex Dental PPO Advantage. $500 maximum benefit and $0 deductible.
$30 – Humana Preventative Plus. $1,000 maximum benefit and $50 deductible.
$46 – Nationwide Mutliflex Dental Classic Select 1500. $1,500 maximum benefit and $50 deductible.
$49 – Nationwide Mutliflex Dental Classic Select 2000. $2,000 maximum benefit and $50 deductible.
$51 – Anthem Dental Prime B. $1,000 maximum benefit and $50 deductible.
$71 – Anthem Dental Family Enhanced. $2,200 maximum benefit and $60 deductible.
Increased Number Of Policy Options
There are two types of Exchange plans available. A “standard” policy won’t deviate from other companies. Benefits will be almost identical so comparing prices will be easy. “Custom” policies allow the insurer to add unique features designed to enhance benefits and make it stand out from the other carriers. Compliant “Exchange” and “Off-Exchange” plans must include 10 “essential” health benefits, so other than deductible, copay, coinsurance, out-of-pocket expenses, and premium differences, core benefits remain quite similar. Since “short-term” and “limited benefit” plans are not compliant, they are not required to include all “essential” benefits.
The availability of “Platinum” Marketplace policies will continue. These “Cadillac” plans feature the lowest copays, coinsurance and deductibles, resulting in the smallest out-of-pocket expenses for individuals and families. Of course, for most persons, they will also be the most expensive option. They will be subsidy-eligible, which will help households that meet the ACA income requirements. However, if there are no major pre-existing conditions, often, the Platinum option is not the most cost-effective choice.
Participating companies do not have to offer Platinum policies to consumers. However, Gold, Silver and Bronze plans are a requirement, and they are the most popular choices. Bronze and Catastrophic policies feature low premiums but also have the highest out-of-pocket costs.
Plan Design Changes
The cheapest of the 2018 Metal tiers (Bronze) features a $7,350 deductible, which is an increase from $7,150. The maximum out-of-pocket expenses for a family plan is $14,700. However, a minimum of three primary-care and mental-health office visits are covered on “catastrophic” plans without having to meet that large deductible. Although a copay must be paid, significant out-of-pocket costs could result if many visits to a specialist are required.
Typically, there is also an added copay on generic prescriptions. It won’t save a substantial amount of premium since most generic drugs are already cheap. But for persons that take multiple medications, it could save hundreds of dollars per year.
Since “catastrophic” plans are not eligible for subsidies, Bronze contracts are often the best combination of value and benefits, since all 10 “essential health benefits” must be included. Healthy CT’s “Basic Plus,” Connecticare’s “CBI HSA,” and Anthem’s DirectAccess HSA are three of the cheapest available plans.
The basic Silver tier policy will trim $400 off its $3,000 deductible to $2,600. And the cost of drugs will get cheaper as the deductible falls to $25 from $400. Maximum out-of-pocket costs will slightly increase, which should help keep prices fairly stable.
Although most consumers do not reach their deductible during a regular calendar year, if you have a serious illness or injury that requires a lengthy hospital confinement, you will easily reach your maximums. Of course, if you are certain these numbers will be reached, a more expensive plan with a lower maximum expenses may actually be cost-effective. For example, a Silver or Gold-tier policy may have a higher premium, but offset the cost with a lower maximum-out-of-pocket cost.
August 2014 – Anthem Blue Cross and Blue Shield and ConnectiCare Benefits had their rate increases turned down by the Department of Insurance. Meanwhile, HealthCT was granted an 8.5% decrease, based on projected lower than expected claims. In 2014, HealthCt’s pricing was among the highest of all participating Marketplace companies.
UnitedHealthcare was asked to provide a new set of recalculated rates since they don’t have a history of relevant historical experience for plans that are “guarantee-issue.” Also, UHC’s allowable administrative expenses were expected to be approximately 5.25% instead of 7.9%.
September 2014 – The Federal Exchange and government website has a new CEO. He is Kevin Counihan, who has resigned as the chief operating officer of the Connecticut Marketplace. Counihan leaves his position after two years of service, and will prepare the .gov website for Open Enrollment, which begins on November 15th.
Jim Wadleigh will be the interim CEO until a full-time successor is named within the next 2-6 months. Wadleigh was previously in charge of information technology for Access Health Ct.
October 2014 – Hartford and Anthem continue to negotiate over several hospitals that are now considered “out of network” for Anthem policyholders. Although emergency situations are not impacted, most other treatments are affected. The impacted hospitals are MidState Medical Center, Backus Hospital, Hartford Hospital, Institute Of Living And Jefferson House, and Windham Hospital, and Hospital of Central Connecticut.
Additional facilities will also be considered “out of network” in November if an agreement is not reached. If ongoing treatment is being administered, special provisions may be made to cover costs. Cancer and other chronic conditions would most likely be considered as one of the exceptions. If you have already scheduled a procedure or surgery, consumers should check with their primary care physician.
October 2014 – More than 75,000 persons enrolled in last year’s Exchange and they will be contacted shortly to notify them of the upcoming Open Enrollment in November. Although everyone can choose to re-enroll, another option is to compare 2015 plan options and pick a new policy and/or a new carrier.
Subsidy calculations may change since the poverty guidelines will be different and four new companies are now part of the Marketplace. And if household income has changed, it could impact the premium you are expected to pay.
October 2014 – In-person helpers will once again help in the enrollment process for 2015 policies. The Connecticut Health Foundation is donating funds that will be used to help low-income applicants obtain affordable coverage. Several of the Agencies include the Hispanic Center of Greater Danbury and the Bridgeport Child Advocacy Coalition. The extra money will help reach many communities that otherwise would not receive any personal assistance.
November 2014 – More than 11,000 persons have applied for coverage during the first week of 2015 Open Enrollment. Last year, about 275,000 persons enrolled in an Exchange plan or Medicaid. By the close of this year’s OE period in February, it is expected that the total number will reach about 350,000.
It is hoped that the percentage of uninsured will fall below 4% by the end of 2015. The Library Association and Department of Labor are helping local residents as navigators, along with other outreach resources in local communities.
December 2014 – Plans that exclude abortion benefits are now available on some Marketplace plans for 2015. Litigation has now been settled with Barth and Abbie Bracy since the Anthem BCBS Gold HMO Pathway X and Silver Pathway X plans are now available. Any potential consumer that requests information regarding the availability of these types of policies, will now be informed of their options.
By 2017, all states must offer policies that exclude abortion coverage. Currently, there still is a fee charged on Exchange policies to pay for these types of claims. Although the surcharge is fairly nominal, it is an extra fee that is unpopular with many residents.
December 2014 – The early winner in Exchange sales is ConnectiCare. Of the approximately 20,000 persons that have so far enrolled, more than 7,000 have selected a ConnectiCare plan. Second is Anthem Blue Cross And Blue Shield with more than 7,000 new customers. UnitedHealthcare, one of the nation’s largest carriers, has signed up about 2,000 persons so far.
March 2015 – Bill No. 1024 “An Act Concerning The Security Of Consumer Data” is being considered by the State General Assembly. Proper encryption of personal information would be required by companies and entities involved in the healthcare business.
Regulations and minimum security standards and guidelines would be implemented within two years of passage of the bill, with necessary updates and changes made in a timely manner. New Jersey passed similar legislation earlier in the year. The Anthem security breech was certainly one of the impetuses of Bill No. 1024.
June 2015 - Anthem has Cigna and Aetna on its potential takeover candidate radar list. Since Anthem Blue Cross ad Blue Shield and Cigna underwrite most of the policies in Connecticut, a merger may lessen competition and perhaps increase rates. The CT Department of Insurance is closely monitoring events and would have to ultimately approve the deal.
However, Cigna did turn down the $47 billion offer from Anthem. The offer corresponds to about $184 per share, which is about $20 higher than the current Cigna share price. Although the negotiating door is not closed ($200 per share might be a more acceptable offer), concerns about regulations and protection of private account information are issues that may need to be resolved.
July 2017 – 2018 Open Enrollment begins November 1, and continues until December 15th. The 45-day period has been reduced from 90 days for all states by the Department of Health and Human Services. Anthem and ConnectiCare are the two carriers that are expected to offer Marketplace plans. Anthem has proposed a 33.8% rate increase while ConnectiCare has requested a 15.2% increase.