Living in Connecticut, you’re surrounded by states that already adopted guaranteed issue health insurance laws before federal health reform. In Massachusetts, New York, and Vermont, there were existing provisions in place for the state to allow anyone to purchase health insurance regardless of their health. Connecticut stayed behind, however, and did not adopt this reform until 2014, when it was a federal requirement. The state was also given two options when it came to implementing the Affordable Care Act on the state level: how to set up the health insurance exchange and whether to increase Medicaid eligibility guidelines.
Since health reform started taking shape in Connecticut in 2010, regulations began altering the course of the health insurance system. These provisions help people obtain and keep coverage, and also decide what insurers are permitted to do. Fortunately for the low-income residents of Connecticut, Medicaid is growing to include an additional group under health reform. Yours is one of many states which have decided to offer free health insurance through Medicaid to a larger population.
The progress of health reform in Connecticut health insurance has been gradual, yet many changes have taken place and will be implemented in the near future. While the lengthy law covers much ground, there are a few key provisions to keep in mind as an insured (or to-be-insured) resident of this state.
Health Care Reforms in Connecticut: 2010-2013
In Connecticut, the state has already complied with several notable changes due to health reform, including the end of rescissions and lifetime maximums, as well as new rules for company spending. Insurers are no longer able to cancel a person’s policy if they become ill, or for any factors other than committing a crime like lying on your application or committing other such fraud. If you pay your premiums, are honest on your application, and don’t attempt to rip off your health plan, your benefits cannot be rescinded. You can be sure you stay covered, as lifetime maximums are not permitted anymore, and annual maximums have been increased each year since the law began. This allows policyholders to stay covered and not pay for health insurance in vain.
The medical loss ratio (MLR) keeps insurers in Connecticut responsible in spending premium income, mandating that 80-85 percent be spent on improvements in care and quality for members. If they neglect to meet this requirement, the company must send each policyholder a rebate check for the amount they should have put towards medical costs.
One improvement insurers cannot avoid is covering preventive care in full with any private health plan. Receiving routine exams and recommended services from in-network providers will never cost you anything additional. As a paying policyholder, the law feels you are entitled to necessary services without charging anything. This includes well-child care, well-woman care, immunizations, cancer screenings, and screenings for other illnesses for which you may be at risk.
Young adults in Connecticut have gained coverage from the new law, which gives individuals up to age 26 the option of staying on their parent’s health plan as a dependent. Insurers also must accept children under age 18 for coverage on the individual market, despite their medical problems. This protection ensures children whose parents are buying their own health plans can stay covered.
Full Implementation of the ACA in Connecticut
Between the end of 2013 and 2015, most of the remaining elements of the Affordable Care Act will have been put in place. This includes the beginning of the Connecticut health insurance marketplace, Access Health CT, whose site opened for business in October 2013. The exchange, operated by the state, will connect residents to all their public health plan options, through Medicaid, Medicare, and through the exchange for individuals. Health plans will include a wide range of essential health benefits, including some that are not usually included in a private individual plan, such as maternity and vision care.
To increase the appeal for the exchanges, the government provides subsidies for coverage to individuals who earn a certain amount for their household (estimated between 138-400 percent of Federal Poverty Level). These tax credits will reduce a significant portion of premiums, potentially costing less than private health plans. Employers can also offer vouchers to their workers to buy a plan through the exchange.
The individual mandate, the law that says if you don’t get insured you have to pay a tax, is another push to get people interested in obtaining coverage, now that they are able to. Although coverage may still be out of reach for some residents of Connecticut, between Medicaid expansion and subsidies many residents are expected to enroll instead of paying the penalty. This rule applies to any form of creditable coverage, from public to private plans, not exclusive to the exchange.
Individual health plans will also change to accept all applicants and only increase premiums based on tobacco use and age. Connecticut also plans to participate in Medicaid expansion, which will offer coverage to an estimated 114,00 people statewide. This means the state Medicaid program will accept enrollees who are childless adults between ages 19 and 64 who earn up to 133 percent of FPL. It is also expected that due to the individual mandate and improved access to insurance, more people who are currently eligible for HUSKY Medicaid will sign up.
1. Kaiser Health Reform. State Exchange Profiles: Connecticut.
2. MedicaidExpansion.com. Medicaid Expansion Connecticut.