Health Insurance Enrollment: Higher Premiums, Less Time To Enroll

Consumers can begin shopping for 2018 health insurance through Access Health CT (AHCT) Wednesday, Nov. 1, but will see sizeable price increases and have far less time to enroll than in previous years.

Officials at the state’s health insurance exchange are boosting marketing and outreach efforts at a time when many consumers may be confused, said Andrea Ravitz, AHCT’s director of marketing and sales.

Despite efforts by President Donald Trump and Republicans in Congress to repeal the Affordable Care Act (ACA), which created AHCT, the legislation and the marketplace still stand.

Grace Montesi, an outreach worker for Access Health CT, explains insurance coverage at a festival at the Peabody Museum, New Haven.

“The constant mixed messages are confusing people,” Ravitz said. “There are certain things that are affecting the federal platform that are not affecting Connecticut at all. There’s a lot of confusion.”

Planned online outages for the federal healthcare.gov website, for instance, will not impact accesshealthct.com, she said, and AHCT’s outreach efforts will not be impeded by federal budget cuts.

One major change from previous years: those renewing plans or enrolling in new ones will have to do so by Dec. 22, and all plans will be effective Jan. 1. In prior years, consumers had until Jan. 31 to enroll and could have start dates later than Jan. 1.

This year, the marketplace has two insurance carriers, ConnectiCare and Anthem. Plans under both carriers will be more expensive than last year, after state regulators approved average increases of 27.7 percent in ConnectiCare’s rates and 31.7 percent for Anthem’s plans.

Amid the changes, ACHT, now in its fifth year, is working to assist consumers. Officials expect about 111,000 people to enroll in plans during open enrollment, roughly the same as last year, Ravitz said.

There will be 10 enrollment centers, up from two last year, where consumers can get free, in-person help. They will be in Bridgeport, Danbury, East Hartford, Harford, Milford, New Haven, New Britain, Norwich, Stamford and Waterbury.

Hundreds of brokers also will be available statewide to offer guidance, Ravitz said. While AHCT enrollment specialists can enroll people in plans, only brokers can recommend certain plans over others, she noted.

AHCT will hold enrollments fairs at various locations statewide every Saturday between Nov. 1 and Dec. 22. Also, the exchange’s online and mobile sites have been upgraded to provide simpler cost estimates and health care provider information.

Grassroots efforts also are under way to connect consumers with resources.

Together We Rise CT, a group of volunteers around the Lower Connecticut River Valley region, is working with Community Health Center in Middletown to spread awareness about open enrollment. The group also will have counselors from the health center at several events to help people enroll, and will offer individuals rides to the center to enroll.

Indivisible, an anti-Trump movement, has Connecticut factions that are doing community outreach and education as well.

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act, sweeping health care reform legislation that requires most Americans to have health insurance or pay a penalty.

During open enrollment people without coverage can shop for insurance plans and those with coverage can renew or change their plans. This year, the marketplace has two insurance carriers, ConnectiCare and Anthem.

The largest premium increases are in mid-level, “silver tiered” plans, which are the most popular on the insurance exchange. Of the 96,000 enrollees in Access Health, more than 60,000 purchased a silver plan.

The 7,700 customers who enrolled in 2017 plans using AHCT and received no financial assistance are enrolled in silver plans and may see higher costs, according to Ravitz. Financial help remains available to consumers who need it, she said.

After open enrollment ends on Dec. 22, consumers can sign up for 2018 coverage only if they have a qualifying life event, such as loss of insurance, marriage or the birth of a child.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

While most people have to wait until Nov.1 to enroll in plans, enrollment in Medicaid Husky and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

Paying The Price For No Insurance

As in previous years, people who don’t have health insurance will face fines in 2018 but they are not increasing over 2017. Most people without coverage in 2018 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child under age 18), whichever is higher.

Consumers will pay the fine on the federal income tax return they file for the year in which they lack coverage. Most people will file 2017 returns in early 2018, and will be asked on their returns whether they had insurance coverage in 2017.

There are some exemptions but the vast majority of consumers need insurance to avoid a fine.

Consumers faced the same fines for lacking coverage in 2016, but those fines were higher than the previous year. In 2015, consumers with no coverage paid 2 percent of yearly household income or $325 per person ($162.50 per child), whichever is higher.

While there are no liens, levies or criminal penalties for failing to pay the fine, those who don’t pay will see it deducted from future tax refunds.

Bans Discrimination For Pre-Existing Conditions: Insurers must cover people with pre-existing conditions and they cannot arbitrarily cancel a policy because an enrollee gets sick.

Free Preventive Care: The law continues to broaden access to free preventive care. New rules regarding testing and medications to reduce the risk of breast cancer went into effect in 2015. Plans must cover (without cost-sharing) risk-reducing medications, such as tamoxifen and raloxifene, prescribed to women with increased risk of breast cancer.

Expanded Coverage For Young Adults: Young adults up to age 26 who do not have access to job-based health insurance can stay on a parent’s plan whether or not they live at home or attend school. The law applies to all health plans, even those that are self-insured.

Annual And Lifetime Dollar Limits: The law ends lifetime and yearly dollar limits on coverage of essential health benefits. That means Connecticut residents with insurance no longer need to worry about going into debt when their coverage runs out.

Essential Benefits: Insurers must provide a minimum level of coverage under 10 categories known as “essential benefits,” including preventive care, emergency services, hospitalizations, outpatient care, maternity services, laboratory services, mental health and substance abuse treatment, pediatric care (including vision and dental), prescription drugs, and rehabilitation and habilitation services. The law applies to all plans sold in the private market or through AHCT—except plans from self-insured employers and grandfathered policies sold before March 23, 2010.

Standardized Benefit Explanations: Health insurers must provide policyholders with standard disclosure forms (no more than four pages) summarizing benefits and coverage, including information about deductibles, copayments, out-of-pocket limits and excluded services. The standard format allows consumers to make informed decisions based on apples-to-apples comparisons of health plans.

Consumer Rebates: Consumers whose private insurance carriers do not spend at least 80 percent of premium dollars on health care and quality improvements can expect to receive a rebate each year.

Prescription Drug Savings For Older Adults: Medicare recipients who reach the prescription coverage gap, known as the “donut hole,” will get a 55 percent discount on brand-name prescription drugs and a 35 percent discount on generic drugs. The donut hole, the point at which people must start paying for their medications, disappears by 2020.

Scrutinizing Premium Increases: Insurance companies seeking premium increase rates of 10 percent or more for plans in the individual market trigger an automatic review by the Connecticut Department of Insurance.

For addresses of Access Health CT’s enrollment centers click here.

Sources: Healthcare.gov, Access Health CT

This report was compiled by Cara Rosner.