Most residents of Connecticut are eligible to buy health insurance through Access Health CT, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Because of the pandemic, Access Health CT’s enrollment window is open through Aug. 15.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
- Connecticut residents, including non-U.S. citizens with worker or student visas, are eligible to buy health insurance through Access Health CT, regardless of whether they are currently insured. The incarcerated are not eligible.
- You may also qualify for the state’s Medicaid programs, called HUSKY Health plans, which offer free or low-cost coverage to low-income singles and families, adults 65 and older, individuals 18 to 64 with a disability, children, and others.
When can I enroll?
- Anytime through Aug. 15, 2021
- Those who’ve lost or will be losing their health coverage and those who’ve experienced a qualifying life change — such as the birth of a child, a divorce or a marriage, or a move to Connecticut — can still enroll after Aug. 15.
- Those who qualify for HUSKY Health can enroll anytime, as can American Indians and Alaska Natives.
How do I sign up?
You apply for coverage and choose your plan at the same time. Once you’re approved for a plan, you’ll need to pay your first monthly premium for coverage to begin. You can pay online or ask to receive a bill in the mail. To apply and enroll:
- Online: Go to AccessHealthCT.com and click “Enroll Now.”
- By phone: Call the Access Health CT call center at 855-805-4325 between 8 a.m. and 5 p.m. Monday to Friday. Assistance is available in more than 100 languages. If you are deaf or hearing impaired, use the TTY at 855-789-2428 or contact them with a relay operator.
- In person: Visit one of the Access Health CT’s in-person enrollment locations.
- By mail: Call the Access Health CT call center at 855-805-4325 to have the correct application form mailed to you.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income and the age and disability status of you and your family.
If you qualify for HUSKY Health, you can get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Access Health CT plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and pediatric care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All Access Health CT plans cover basic dental services for those 18 and younger, including cleanings and exams. HUSKY plans offer dental coverage for adults as well. But adults who want dental coverage must add it to their Access Health CT plan. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums. For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction (CSR) that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for an almost $0/month premium health coverage option, thanks to the American Rescue Plan. This subsidy will become available in July. If you’ve already received unemployment benefits this year while enrolled in a marketplace plan, you’ll be able to claim the additional subsidies for the months prior to July when you file your 2021 tax returns. This extra financial help will expire at the end of 2021.
What plans are available?
Access Health CT’s plans areorganized into categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover between 70 and 94 percent of care costs, depending on which cost-sharing reductions you qualify for.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums. Currently, there are no platinum plans offered in the Access Health CT marketplace.
- Catastrophic plans are available to Connecticut residents under 30 or to those who have been granted a hardship or affordability exemption from Access Health CT. They offer low premiums and cover three primary care visits per year. You are not eligible for financial help for these plans.
Access Health CT’s Compare Plans tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance.
Access Health CT also offers the Certified Independent Broker program, which helps customers find a local broker to help with plan selection or questions. You can also call 855-805-4325 to speak with a broker.
What if I already have health insurance?
If you already have coverage through your employer, you can switch to an Access Health CT plan through Aug. 15. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.83 percent of your household income for individual coverage or more than 8.27 percent for family coverage in order for you to qualify for the tax credits.
If you have coverage through a plan that’s outside the exchange you can also enroll in an Access Health CT plan through Aug. 15. If you decide to swap plans but stick with the same insurance provider, any cost-sharing amounts you’ve incurred, such as deductibles and covered out-of-pocket costs, should carry over. Contact your insurance company to confirm and to ask about changes to provider networks and prescription drug benefits for Access Health CT plans.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours, you should be receiving a temporary COBRA premium subsidy that covers 100 percent of your monthly premium cost. This premium assistance, made possible through the American Rescue Plan, runs through the end of September or the end of your last month of COBRA eligibility, whichever comes first.
If you’re on COBRA, you may want to sign up for a marketplace plan that starts as soon as your COBRA coverage ends. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker.
Will I need to get a new doctor?
Maybe. Not all doctors accept marketplace plans. You can talk to your primary care physician or use the Compare Plans tool to see whether a doctor or practice is in the plan’s network. You can also check the websites of Access Health CT insurers Anthem and ConnectiCare to search for covered providers.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status.
HUSKY Health plans have their own provider networks, but there is a lot of overlap between their providers and those in the Access Health CT plans. This often allows family members on different plans to visit the same doctor or medical provider.
This guide, originally published June 16, was updated June 25 with new information on financial help for those who’ve collected unemployment benefits in 2021 and those on COBRA.
Also of Interest:
- Your ACA checklist
- COVID-19 coverage under the ACA
- Test your knowledge of health care rules
- ACA Out-of-Pocket Max Costs Will Drop in 2022
Publisher’s Note: The ACA has narrowed racial gaps in access to health care but Hispanics-Latinos are still nearly three times more likely to be uninsured.
CTLN partners with AARP Connecticut in best serving the Hispanic-Latino community.