Affordable care act Connecticut Archives

Health Reform Connecticut

Health Reform (Affordable Care Act) will have a major impact on most Connecticut residents. The mandatory changes will be taking place in Connecticut on January 1st, 2014. How will health reform effect you? It mostly depends on how you access health care. Those on Individual health plans will have major changes while people on large employer plans may not notice much change.

Health Exchange- This term is widely used when describing Health Reform. The Health Exchange is a place where individuals (There will be a group/company exchange as well) can go to find a health care plan. The plans in the exchange will all be similar from a benefits standpoint and companies will need to meet minimum benefit and pricing standards to have an offering. There is a link below which provides more information on the Exchange. There is very little information available on the group exchange.( Called SHOPs -Small Business Health Options Programs) Small groups will be eligible for the premium credit through the group exchange only.

Each state has decided if they will administer the new program on their own or use the Federal Government to do it. The initial thought in congress was that most states would be running their own Exchange which turned out to not be the case As it stands today, 50% of the states have opted to have the federal government run the Exchange.

We have broken down the changes into categories below with a summary of changes for each group effected. Click on the links to learn more about each section. If you have additional questions, you may call our office or send me an email any time. Emails may go to Edward@Croweandassociates.com

CATEGORIES- CLICK BELOW FOR INFORMATION ON TOPICS

Health Reform for Individuals and Families Connecticut

Health Reform for Small Groups Connecticut

Health Reform for Large Groups Connecticut

Health Reform For Indviduals and Families Connecticut

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	Actuarial value of coverage
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.