10 Things You Need to Know about Health Insurance Exchanges

Frequently Asked Questions and Answers for Connecticut Consumers and Small Businesses

Jun 03, 2013, 11:24 ET from Access Health CT

HARTFORD, Conn., June 3, 2013 /PRNewswire/ -- Starting October 1, more than 350,000 of Connecticut's uninsured will have the opportunity to receive health insurance coverage, many for the first time.  Although it seems like months away, smart shoppers will want to know as much as possible as soon as possible.

Access Health CT, one of the first federally approved state exchanges formed under the Affordable Care Act (ACA), is committed to educating people about the enrollment process and their choices.  This is especially timely in light of a recent poll by the Kaiser Family Foundation that reports the public actually knows less about the ACA now than when it passed in 2010.  As part of its education effort, Access Health CT has been holding Healthy Chat town hall meetings with residents across the state to answer their questions and get their input.

"Based on our Healthy Chat discussions and our ongoing outreach, we thought it would be helpful to put together a list of the 10 things that individuals and small businesses should know now," said Access Health CT's CEO, Kevin Counihan. "We are working aggressively to expand access to affordable, high-quality health care coverage and recognize that selecting insurance for your family or employees is a very important decision.  We want to make sure people have sufficient time and all the information needed."

1. What exactly is the Affordable Care Act (ACA)?  Sometimes called Obamacare, the ACA aims to overhaul the healthcare system for the first time since the passage of Medicare and Medicaid in 1965.  The law includes many provisions such as expansion of Medicaid eligibility, the establishment of health insurance exchanges, and prohibiting health insurers from denying coverage due to pre-existing conditions. 

2. What is Access Health CT?  It's Connecticut's health insurance exchange, a quasi-public state agency that was established as a key part of the Affordable Care Act with the endorsement of the Connecticut Legislature.  Access Health CT works as a new kind of marketplace, where a range of qualified, approved health insurance plans from brand-name carriers are offered to individuals, families and small businesses.  Eligible consumers and small businesses may qualify for discounts in the form of tax credits.  You will be able to compare plans, find out if you are eligible for discounts, and enroll in the right plan for you.

3. Who qualifies?  Anyone can shop for and purchase health insurance via Access Health CT.  However, the main purpose is to help individuals who have not been able to afford or qualify for insurance in the past to find more affordable plans and finally be eligible for insurance.  In addition, small businesses with 50 employees or fewer will be able to purchase health insurance from the exchange.  It is estimated that more than 36,000 small businesses in Connecticut will be eligible for a tax credit for two years of up to 50 percent of their contribution, but only if they purchase through Access Health CT. 

4.  How much will this cost?  In the U.S., the reality is that health care costs and insurance costs are high.  But Access Health CT will be making robust health insurance plans accessible through tax credits which ultimately mean lower costs. It's important to note that you can qualify for tax credits only if you purchase through Access Health CT.  No one will pay more than 9.5 percent of household income on health insurance and many will be capped at just two or three percent.  Competition between insurance companies in this new marketplace will also help drive costs down over time.

5. How do cost benefits work?  If you earn up to $45,960 a year, or if you are a family of four, for example, earning up to $94,200 a year, you may qualify for a discount.  These discounts come in the form of tax credits, ultimately reducing your health insurance costs. Access Health CT's website (www.accesshealthct.com) features a calculator that can help you determine what your costs and savings may be.  Small businesses that qualify will also benefit from discounts in the form of a tax credit.

6. When should I enroll and how?  Enrollment period begins October 1, 2013 and ends March 31, 2014. Like other insurance programs, there will be an annual open enrollment period going forward.  You will be able to enroll online at accesshealthct.com or via a toll-free number.  Arrangements will also be made for in-person assistance through your local insurance broker and community-based navigators.  Information will be available in English and Spanish, as well as dozens of other languages.  

7. What if I couldn't get insurance before?  Many consumer reforms have taken place that will help people who didn't previously qualify to finally get insurance.  For example, if you have a pre-existing condition, you can no longer be excluded.  And, your previous medical history cannot be used to charge you a higher rate.   

8.  What about Medicaid?  Access Health CT will serve as a single point of entry for all CT residents to determine their eligibility for Medicaid/HUSKY programs.  Thanks to an expansion of Medicaid under the Affordable Care Act, all Connecticut citizens in households under a certain income level – up to $15,400 for a single person or $31,809 for a family of four – will be eligible for Medicaid.

9. What happens if I don't sign up?  The federal government is setting first year fines for consumers at $95 or 1% of income, whichever is greater. Fines will increase in future years to $325 (or 2% of income) in 2015 and $695 (or 2.5% of income) in 2016.  Small businesses with fewer than 50 full-time employees are not required to provide insurance.  However, those that offer insurance may be able to receive new tax credits valued at up to 50% of their contributions towards their employees' premiums.  Small businesses with more than 50 employees will be required to provide insurance or they will pay a fine.  The fines are meant to encourage people to enroll in an insurance plan, and help people realize the benefit of enrollment.  Having health insurance means taking care of yourself and your family.  You will be eligible for preventative care and free physicals.  Not having any health insurance is a huge risk—the majority of bankruptcies are related to health bills.

10.  Will I have a large network of doctors to choose from?  Yes. For insurance carriers to qualify for Access Health CT, they must meet certain requirements. One is that their plans include a robust network of doctors, clinics and hospitals in local communities.

There's a lot to know about how this new way to purchase insurance can help you and your family or small business.  More information and an extensive list of frequently asked questions and answers can be found on the Access Health CT website at http://www.accesshealthct.com/how-it-works/faqs/.  Access Health CT is also planning more Healthy Chat events and other ways to further educate and assist individuals and small businesses.

About Access Health CT

Access Health CT (also known as the Exchange) was created by the Connecticut Legislature in 2011 and is a quasi-public agency established to satisfy requirements of the federal Affordable Care Act.  Its mission is to increase the number of insured residents in Connecticut, promote health, lower costs and eliminate health disparities. Its vision is to provide a simple online shopping and enrollment experience for state residents and small businesses, starting with open enrollment in October 2013.

Access Health CT will ensure that participating health plans meet certain standards, and will facilitate competition and choice by rating the quality of each plan. Individuals and families buying coverage through the Exchange may qualify for tax credits on premiums. The Exchange will also coordinate eligibility and enrollment with state Medicaid and Children's Health Insurance Programs. More information is available at www.AccessHealthCT.com

SOURCE Access Health CT