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Affordable Care Act Enrollment And Plan Changes

We want to make sure everyone is aware of both the Affordable Care Act Enrollment And Plan Changes. Affordable Care Act plans (Also called Obama Care) are those purchased through the Connecticut Exchange via the Access Health Website.   A premium subsidy is only available to those who enroll through the Access health site.  Anthem , Connecticare and Healthy Partners are the three insurance companies available through the exchange.   People that enrolled outside of the exchange are not eligible for any type of premium help.  For those that did enroll via the exchange there rules regarding new enrollments and plan changes for existing members.

New Enrollments–

The general period for someone to register and enroll in a plan through the Access Health site ended on March 31, 2014. The site does not accept new enrollments for the remainder of the year.  A new enrollment window will open in October of 2014.  This will allow new members to apply for a January 1, 2015 start date.

Special Election Period–

Additionally, some people are allowed to enroll in a plan outside of the enrollment period.  This is true if they have a special election reason to do so.  Special elections reasons include, losing group health insurance or an individual health plan during the year, moving to a different state, a change in Medicaid or Husky status and losing COBRA benefits.

Plan Change for existing members–

In fact, Existing members are not allowed to make a plan change outside of the normal enrollment period. This is true, unless they qualify for one of the special election periods above.  A doctor who decides to no longer accept or participate with a Affordable Care Act plan during the year is not a valid reason to make a plan change.

Crowe and Associates is here to help you.  Call us if you have any questions about health insurance.  Please contact us either by phone at (203)796-5403 or by email at Edward@croweandassociates.com.

Health Reform Companies Connecticut

This post will give you some information about Health Reform Companies Connecticut.  There are three companies participating with the health exchange in Connecticut as of January 1, 2014.  They are as follows,  Anthem BlueCross BlueShield, Connecticare as well as Healthy CT.   Anthem and Connecticare have both been operating in Connecticut for many years.  Healthy CT is a new not for profit that is run by the State of Connecticut.

All three companies offer Bronze, Silver as well as Gold plans in the state of Connecticut. Because the benefits these companies offer are standardized by the insurance industry, they  must all have consistent plan designs. This helps  to make your decision a little easier. You just have to see which arrier offers the best pricing and used the providers you prefer .  There has been some discussion about Platinum level plans but they are not available in Connecticut this year.  Although United Healthcare does not participate in the individual exchange,  they are available through the small groups exchange however.  (Small Group Exchange is called SHOP Exchange)

Access Health operates The Connecticut Exchange.   They also operate the website that clients use in order to apply for the plans.  Access Health will also determine if applicants are eligible for a subsidy to help them pay for their coverage.

CLICK HERE TO LEARN MORE ABOUT HEALTH INSURANCE ON AND OFF THE EXCHANGE IN CT

If you have any questions, you may either email our office at Edward@Croweandassociates.com or call us at 203-796-5403.  We are here to help you make the right choice for your insurance needs.  Each person has  both different financial as well as health care needs.  Crowe and Associates wants to make you feel confident with your choice of health care options.

Access to doctors with health reform

This post will give you information about your Access to doctors with health reform.  The new health reform plans that are created and will be ready to go either through the State or Federal Exchange by January 1, 2013.   The plan designs have been decided by  the carriers who participate.   In fact, the criteria that the carriers use to determine rates is  established.  So what will the provider network look like?

Read more

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 (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.

The Affordable Care Act brings major changes for large group employers in Connecticut. Employers that meet the definition of “Large Group” will need to meet thresholds for affordable care and adequate coverage.  Failure to meet the guidelines will result in penalties for the employer.  Employer groups will

In Connecticut, a large group is one with more than 50 eligible employees however, the definition of a small group will change some time between 2014 and 2016 as the number will be moved groups with 100 or more eligible employees. Full time, part time and seasonal employees count toward the total amount of employees eligible.   A portion of part time employees count toward the full time total.  This number can be determined by multiplying the average number of hours worked per month by the number of part time employees and then dividing by 120.  Example:  40 seasonal employees working an average of 90 hours a month divided by 120  40 x 90 divided by 120 = 30 extra full time employees.  Multiple companies with the same EIN number must also be combined.  If a there are multiple companies with under 50 employees under the same EIN, the employee count will be combined to determine groups size.

Seasonal employees’ hours are included when determining applicable large employer status.  An employer will not be a large group if it employed 50 or more full-time employees for no more than 120 days in he preceding calendar year and the employees causing it to reach or exceed the 50 full-time employee threshold were seasonal for more than 120 days.

Large groups will face a penalty if they have an inadequate or unaffordable offering.  The penalty will be $2,000 per employee per year, excluding the first 30 employees.    The penalty will only be triggered if an employee goes to the individual exchange and qualifies for a subsidy.   If an employee does not qualify for a subsidy on the exchange, the employer will not be subject to a penalty.  Spousal coverage is not a requirement for employers and the will not be penalized if a spouse is able to receive a premium tax credit on the exchange.

The changes listed above will not be applicable to groups with renewals in 2013.  For example, if a groups renews the group insurance plan in October of 2013, they will not be subject to the new guidelines until October 1, 2014 when the plan renews.  It is likely that many groups will look at a late year renewal as a means to buy more time and avoid the new guidelines for another 12 months.