With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Connecticut, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Connecticut
Connecticut ranked 7th in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths included a low prevalence of smoking, a low incidence of infectious diseases, and high immunization coverage among children and adolescents. Challenges included a moderate prevalence of binge drinking, low high school graduation rate, and large disparity in health status by educational attainment.
Connecticut individual and family health insurance
When the Affordable Care Act’s first open-enrollment period began Oct. 1, 2013, Connecticut launched a state-based health insurance exchange, Access Health Connecticut.
Individuals and families in Connecticut may also buy qualified Obamacare health insurance plans in the private marketplace through sites such as HealthCare.com. Use HealthCare.com’s tax subsidy calculator to see if you are eligible for an Obamacare tax credit. If you are, shop and enroll in a health insurance plan at Access Health CT.
The U.S. Department of Health and Human Services reported that 79,192 individuals in Connecticut selected a marketplace plan from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Connecticut enrolled in a marketplace plan increased to 109,839 during the open enrollment period.3
|Connecticut’s health insurance exchange:||accesshealthct.com|
|Connecticut department of insurance:||ct.gov/cid|
Connecticut small group health insurance plans
In Connecticut, small businesses with 50 or fewer employees may purchase small group health insurance plans through the state-based exchange at accesshealthctsmallbiz.com. Small businesses that use Connecticut’s small business marketplace and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Connecticut’s small business owners may also find small group health insurance in the private marketplace through websites such as such as HealthCare.com. Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Connecticut’s state-based health insurance exchange.
Connecticut state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Details from Connecticut’s small group COBRA continuation law include the following4:
|Mini-COBRA option||Yes – Connecticut Continuation Coverage|
|Eligible group sizes||All sizes – under and over 20 employees|
|Maximum continuation period – standard||30 months
Those who work for groups of 20 or more and qualify for federal COBRA coverage may add on additional months of Connecticut Continuation for a combined total of 30.
|Maximum premium Increase||102 percent – full group premium cost, plus a 2 percent administrative charge|
|State legislation reference||Public Act 10-13|
|More Information||800-203-3447 – Connecticut Insurance Department Consumer Affairs Division|
|Additional notes||Qualifying events include layoff, reduction of hours, leave of absence and termination of employment for reasons other than gross misconduct.|
Connecticut high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated. 5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Connecticut expanded its Medicaid program to individuals earning up to 138 percent of the federal poverty level on Jan. 1, 2014.7
The information below is specific to Connecticut’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||State of Connecticut|
|How to apply online||Visit huskyhealth.com, and select “How to Qualify” from the menu on the left.|
|Phone number||877-CT-HUSKY (877-284-8759)|
|Open-enrollment period||Year-round in all states|
|Eligibility||Connecticut residents 19 to 65 with qualifying annual income levels and do not qualify HUSKY A, do not receive Medicare and are not pregnant may qualify for HUSKY D, which was expanded under the Affordable Care Act.|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Connecticut’s health insurance program for low-income children:
|Program name||HUSKY B|
|How to apply||Visit huskyhealth.com, and select “How to Qualify” from the menu on the left.|
|Eligibility||Connecticut children under age 19; family income guidelines apply|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Connecticut Insurance Department. “Continuation of Group Health Coverage Expanded to 30 Months – Frequently Asked Questions.” N.D. Retrieved from http://www.ct.gov/cid/lib/cid/30_Month_Continuation_Fact_Sheet.pdf.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Connecticut.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/connecticut.html.