Access Health Connecticut: the state's health insurance portal
By Denise Coffey - Staff Writer
Connecticut - posted Wed., Dec. 18, 2013
When the Affordable Care Act rolls out on Jan. 1, 2014, between 320,000 and 384,000 Connecticut residents will become eligible for health insurance coverage. That number translates to one in eight residents and includes approximately 44,000 children. Individuals, families and small businesses are eligible to apply. It’s a sea change not only for about 10 percent of Connecticut’s population, but for an estimated 30 million Americans across the country.
How many Connecticut residents enroll remains to be seen. To date, more than 25,000 have applied through the state’s health insurance marketplace, Access Health Connecticut. Of that number, 24,838 have been determined to be eligible to enroll in a marketplace plan, according to data from the Kaiser Family Foundation. More than 16,000 are eligible for financial assistance, and nearly 13,000 have been assessed as being eligible for Medicaid or CHIP.
The good news for state residents is that Access Health Connecticut, one of only 17 state-run health insurance exchanges, has a website that is fairly easy to navigate. The enrollment centers are limited to two - one in New Haven and the other in New Britain. But the state has put in place In-Person Assisters, or Navigators, that can assist people with their applications. And people can also apply over the telephone. All services are free of charge.
For those residents interested in applying for coverage, there are a slew of factors to consider. A consolidated version of the Affordable Care Act (its full name is “Patient Protection and Affordable Care Act”) put out by the U. S. House of Representatives is 974 pages long. The details are mind-boggling.
But Access Health CT (www.accesshealthct.com), which was established to meet the requirements of the Affordable Care Act, is a good place to start. It provides answers to frequently-asked questions and breaks down some of the main provisions of the plans offered. Together with the U.S. government’s website, www.healthcare.gov, they provide some of the most important information an applicant needs to know when signing up for coverage.
To be eligible, a Connecticut resident must live in Connecticut, be a U.S. citizen or lawfully present, and cannot currently be incarcerated. If you need coverage, your employer doesn’t offer coverage or it’s too expensive, you’re self-employed, you’ve been denied due to a pre-existing condition, or you’re looking for savings, you are eligible for coverage.
The application process can take as little as 30 minutes. An enrollment matrix on the website asks questions about county of residence, age, annual income and the number of members in a household. The insurance wizard that pops up then provides a list of health care plans available. That pop-up list gives a snapshot of benefits, including the monthly premiums, deductibles, co-payments and out-of-pocket maximums that go along with each plan.
From that point, an applicant can get more detailed information on key items such as plan overviews, physician services, pharmacy benefits, emergency room and urgent care costs, hospital services, outpatient services, substance abuse, mental and behavior health, habilitative and rehabilitative services, pediatric care and pediatric dental care.
Generally speaking, the higher the premium, the lower the deductible. Individuals with medical conditions might opt for plans with higher premiums because they know they will use their plan for certain procedures and doctor visits. Young, healthy individuals might opt for a plan with higher deductibles and lower premiums.
While the process can be simple, it’s important to familiarize yourself with insurance terminology and the differences in how plans operate before making a decision. Knowing the difference between an HMO (Health Maintenance Organization), a PPO (Preferred Provider Organization) and a POS (Point of Service) plan allows for better decision making.
HMOs limit coverage to in-network providers only, except in the case of emergencies. PPO and POS plans charge less when patients utilize in-network providers. Knowing which providers are in-network (there is a link on the website that provides that information) can save a patient a significant amount of money.
Out-of-pocket maximums, annual deductibles, what the co-payment structure is for primary care physicians versus specialists, exclusions and appeal processes are defined in detailed plan documents that are available for review on the website. So are important terms and conditions of care. Applicants are advised to read through these to understand the implications of their choices. For instance, if a member uses a non-network provider, and the insurance carrier is obliged to pay a maximum allowed amount, it could leave the member paying the difference between the provider's charge and what the insurer pays. That difference can be significant.
Plan documents can run up to 100 pages. It’s worth the time and effort to read through them. And it’s worth noting that penalties may be assessed on those who do not sign up for health care by March 31, 2014.
To be eligible for enrollment in a health plan for Jan. 1, 2014, applications and premium payments must be made by Dec. 23. If applications and premium payments are made between the 1st and 15th of the month, coverage begins on the first day of the next month. If applications and premium payments are made between the 16th and 31st of the month, coverage begins on the first day of the second following month. A Feb. 16 enrollment means coverage starts April 1. A March 31 enrollment means coverage begins on May 1.
Enrollment will be closed for the year after March 31, 2014, unless a life event (birth of a child, loss of job-related insurance) necessitates getting new coverage. Otherwise, individuals will need to wait for the annual open enrollment period.
For more information, go to www.accesshealthct.com, or call the toll-free number at 855-805-4325.