Health Reform (Affordable Care Act) uses state and federal exchanges to organize health care offerings. Each state had to choose to offer their own exchange or instead, utilize the federal governments exchange. Connecticut decided to create their own as did about 50% of the states.
Start Date: The Connecticut based exchange will be up and running on January 1, 2014. The enrollment period will start on October 1, 2013 for a coverage start date of January 1, 2014.
Who Can Get A Plan?: Just about any Connecticut resident under the age of 65 can get a plan starting in January. There are no exclusions for health conditions and pre existing conditions and not be taken into consideration.
What are the Benefits?: There will be 4 plan types offered in the exchange called Bronze, Silver, Gold and Platinum. The Bronze has the lowest benefits and they increase by plan with the Platinum having the best benefits. Basic benefits levels are 60% coverage Bronze, 70% Silver, 80% Gold and 90% Platinum.
Kaiser summarized the benefits in this manner:
- Households between 100 percent and 150 percent of the federal poverty level can get a plan that covers 94 percent of costs (more than a platinum-level plan would) with an out-of-pocket spending cap that’s one-third of the standard HSA level.
- Households between 150 percent and 200 percent of the federal poverty level can get a plan that covers 87 percent of costs (more than gold, less than platinum) with an out-of-pocket spending cap that’s one-third of the standard HSA level.
- Households between 200 percent and 250 percent of the federal poverty level can get a plan that covers 73 percent of costs (just above the silver level) with an out-of-pocket spending cap that’s one-half of the standard HSA level.
- Households between 250 percent and 300 percent of the federal poverty level can get a silver plan with an out-of-pocket spending cap that’s one-half of the standard HSA level.
- Households between 300 percent and 400 percent of the federal poverty level can get a silver plan with an out-of-pocket spending cap that’s two-thirds of the standard HSA level.
How Much Does It Cost?: The amount of premium that an individual or family pays is based off the federal poverty level. The poverty level for an individual in 2012 was $11,170 and increases with each additional family member. The plan rates are reduced for those within 400% of the poverty level. Those earning over 400% will not be eligible for a subsidy and will pay the full premium. The subsidy is based on a percentage of income that can be paid. NOTE: There are examples at the bottom of this post giving examples of the actual monthly cost.
| Table 1: Premium and Cost-Sharing Subsidies Under Health Reform[2] |
||||
| Income | Required Premium Contribution | Actuarial value of coverage | ||
| Percentage of poverty line | Annual dollar amount |
Percentage of income | Monthly dollar amount | |
| Family of four | ||||
| 100 – 133% | $23,550 – $31,322 | 2% | $39 – $52 | 94% |
| 133 – 150% | $31,322 – $35,325 | 3-4% | $78 – $118 | 94% |
| 150 – 200% | $35,325 – $47,100 | 4-6.3% | $118 – $247 | 87% |
| 200 – 250% | $47,100 – $58,875 | 6.3-8.1% | $247 – $395 | 73% |
| 250 – 300% | $58,875 – $70,650 | 8.1-9.5% | $395 – $559 | 70% |
| 300 – 350% | $70,650 – $82,425 | 9.5% | $559 – $652 | 70% |
| 350 – 400% | $82,425 – $94,200 | 9.5% | $652 – $745 | 70% |
| Individual | ||||
| 100 – 133% | $11,490 – $15,282 | 2% | $19 – $25 | 94% |
| 133 – 150% | $15,282 – $17,235 | 3-4% | $38 – $57 | 94% |
| 150 – 200% | $17,325 – $22,980 | 4-6.3% | $57 – $121 | 87% |
| 200 – 250% | $22,980 – $28,725 | 6.3-8.1% | $121 – $193 | 73% |
| 250 – 300% | $28,725 – $34,470 | 8.1-9.5% | $193 – $272 | 70% |
| 300 – 350% | $34,470 – $40,215 | 9.5% | $272 – $318 | 70% |
| 350 – 400% | $40,215 – $45,960 | 9.5% | $318 – $364 | 70% |
Connecticut Premiums Examples:
Single Example: In Connecticut, an individual making less than $16,000 will be eligible for Medicaid, those making $25,000 a year will pay $144 a month for the Silver Plan. An individual making $45,000 will pay $341.00 a month and a person making more than 50K will pay the full premium which is yet to be determined but will be a substantial number.
Family Example- A family of 4 making less than $31,000 will be eligible for Medicaid, if they make $40,00 they will pay $165.00 a month, making $60,000 a year will be $410.00 a month, $80,000 a year will be $633.00 a month and those over $95,000 will pay the full cost of the plan.
Individuals and Families already on non group health plans- For those that already have a non employer based health insurance plan, it is not yet known if they will be able to continue their plans or if they will need to come off the plans on 1-1-12014. I will update this post when more information is available.