Catastrophic health insurance plans in Connecticut can substantially reduce rates for individuals and families paying for their own policy that are concerned with unexpected illness and accident expenses. By increasing the major medical deductible, often premiums can reduce by as much as 50%, saving thousands of dollars per year. Increasing the maximum out-of-pocket expenses can also reduce the premium. Currently, $7,350 is the highest out-of-pocket limit for a qualified Marketplace plan.
We help find low-cost medical plans through Access Health CT (and off-Exchange options) and explain which policies would be the most cost-effective for you. There are specific requirements you must meet to purchase some of the Marketplace policies. “Off-Exchange” plans are also available, which can be ideal for high-income households or persons that missed Open Enrollment.
Before comparing the most affordable options, let’s quickly define exactly what “catastrophic” plans cover…and just as importantly, what they don’t cover. Typically, there is a deductible to meet. Although there are several deductible options, the higher ones, such as $7,350 and $5,000 are the most popular. However, sometimes the $3,500 option should be considered if you feel there is a higher risk of meeting the deductible for the current year. Generally, on a family plan, a maximum of two deductibles must be met.
The reason is simple. If the chances are high that you’re not going to meet a lower deductible of $2,500, then it makes economical sense to pay far less in premiums by increasing it to a higher amount. You pay no more out of pocket expense in most years, but save a substantial amount of money in premiums in all years! This is also the basic concept of a Health Savings Account, which also includes a separate tax-free side fund for additional contributions.
It’s also important to understand that not everyone can purchase these types of plans when applying for Access Health CT coverage. You must be under age 30 to buy a catastrophic Marketplace policy. Or, you can qualify for an exemption by getting certification that you have a “hardship” situation.
“Hardship” is awarded if the cost of a policy exceeds 8% of the household income. The cheapest offered Bronze plan is used for this calculation. A family policy can qualify as long as each person meets the specific guidelines. Tax credits, however, do not apply. So, it is possible that a higher-tiered plan (perhaps Silver) may be a better choice because of cost-sharing features.
HSA Plans In Connecticut
An HSA plan allows a maximum individual out-of-pocket expense of $6,350 (increasing to $6,450 in 2015). The maximum family amount is $12,900 in 2015. If you would like additional information on contract requirements, please contact us. We can also provide a copy of Revenue Procedure 2014-30, which provides inflation-related adjustment information for this type of policy.
The Anthem Blue Cross And Blue Shield DirectAcess is a very moderately priced HSA option. Another plan that offers reasonable pricing is the ConnectCare Bronze CBI Plan 1. Both policies are “guarantee-issue,” so no medical questions or underwriting is required. And they qualify as HDHP contracts, allowing for the side savings account for tax-free deposits to pay qualified expenses.
We wrote an extensive article here about these types of plans. Although not ideal for everyone, they are very cost-effective and allow you to take much better control over the decision-making process of any treatment you may receive.
If you only need a policy for less than 12 months, you can read about short-term plans here. They are the least expensive type of plan available and are very suitable if you are not currently working or are facing a lapse in your existing coverage. But there are some gaps in benefits, so it’s recommended that you consult us first before purchasing a policy.
Also, temporary contracts, although, cheap, popular, and quickly approved, don’t meet the strict ACA (Obamacare) guidelines. So although larger claims are well-covered, gaps in RX and office visit coverage (and maternity) cause a 1% (of your income) surcharge to be imposed.
Ct Catastrophic plan benefits are very simple. If you’re admitted to a hospital, most/all expenses are covered. An ER visit or an outpatient surgery is also going to be covered. And typically, expenses related to a hospital confinement such as physician fees and anesthesia, are included in the benefit package.
The passage of “The Affordable Care Act” required insurers to cover most expenses that you will have. However, deductibles and coinsurance can vary from one contract to another. Also, not all contacts are available statewide.
You can also expect that most surgeries will be covered at or close to 100%. And premiums can always be paid on a monthly basis. You can also consider a Health Savings Account (HSA) (earlier discussed) for additional savings.
However, so that premiums can remain low, a routine visit to the doctor and most prescriptions will have to be paid by the insured. Unless there are a large number of specialist visits or brand-name prescriptions, the out of pocket cost should be far less than the premium savings. In many situations, non-generic drugs are available that can potentially save thousands of dollars each year. And you may be able to obtain a free RX discount card that are widely offered.
CT Marketplace Rates
Using the example of a 40-year old single male lives in the Hartford area and makes $30,000 per year, the BronzeDirect Access, offered by Anthem Blue Cross Blue Shield, costs only $113 per month after the federal subsidy is applied. There are eight plans that are available for under $200 per month, including the Healthy Partner Essential plan (from HealthyCT) that offers a low $3,000 deductible. The Healthy Partner Max (also from HealthyCT) has a $1,000 deductible.
Although these types of policies are popular with adults, they aren’t often used with dependent children or anyone under the age of 25. The reason is simple. Typically, in Connecticut, health insurance rates are very low for younger persons. So while a high-deductible plan will lower premiums, the difference will only be a fraction of the savings you might see with an adult. Therefore, on young adults below age 24, a policy with more robust benefits will make better sense.
We’ll help you shop for the right catastrophic policy. By reviewing every major carrier’s plans, we can find the specific options that will make the most economic sense for you. Although you should never purchase coverage for unneeded benefits, protecting against larger claims is critical. That’s where we can help determine which policies are the best fit for your specific needs.
UPDATE: June 3 2014 – Beginning in 2015, there will be more HSA options available to consumers. New regulations require each company that offers plans, must also offer high-deductible “Bronze” Tier policies that are HSA-eligible. This should increase the number of low-cost plans that are offered through the Marketplace. Prior to 2015, the only high-deductible options were “non-standard” plans.