Health Insurance Enrollment: Fewer Options, Higher Premiums

Consumers can begin shopping for 2017 health insurance through Access Health CT (AHCT) starting Nov. 1, but they will encounter fewer options and steeper prices than in previous years.

Now in its fourth year, the state’s health insurance marketplace looks different than it has in the past. Most notably, it has only two insurance carriers, ConnectiCare and Anthem, instead of four.

State insurance regulators approved a 17.4 percent increase in ConnectiCare’s rates for exchange plans and approved a 22.4 percent rate hike for Anthem’s plans.

With the high-profile departure of UnitedHealthcare from the exchange and health insurance co-op HealthyCT going out of business, consumers will no longer be able to enroll in those plans.

That means consumers currently enrolled in UnitedHealthcare and HealthyCT plans must find alternative options by Dec. 31. The exchange currently has about 9,500 people enrolled in HealthyCT and 1,800 in UnitedHealthcare plans, according to AHCT officials.

AHCT officials expect the exchange to enroll 125,000 consumers in plans during the upcoming open enrollment period that runs Nov. 1 to Jan. 31, up from 116,000 last year, said Andrea Ravitz, marketing director.

Of those currently in plans bought on the exchange, 60 percent are enrolled in either ConnectiCare or Anthem, which should soften the blow of other carriers leaving, she said.

Still, she said, “We want to make sure that people understand that if they chose [UnitedHealthcare or HealthyCT] in the past, those companies are no longer a choice.”

The Marketplace

AHCT is the online marketplace created by the Affordable Care Act (ACA), 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.

For 2017, consumers can shop on the marketplace for plans offered by ConnectiCare and Anthem. Open enrollment runs Nov. 1 through Jan. 31, but individuals must enroll in plans by Dec. 15 if they want coverage to begin Jan. 1.

After open enrollment ends Jan. 31, consumers can sign up for 2017 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.

AHCT call centers are being operated by a new vendor, Faneuil Inc., which Ravitz said should result in better customer service. The vendor was chosen following an open-bid process that included prior client recommendations, among other things. AHCT hired Faneuil in September.

Also new this year, Faneuil is hiring about 20 insurance brokers to help consumers by phone and in person at enrollment centers. In previous years, insurance carriers had incentivized brokers to enroll consumers in exchange plans by paying them a commission—about $16 per member per month—but the carriers are no longer paying those commissions, Ravitz said, so AHCT has devised a short-term plan to give consumers access to brokers.

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 2017 but they are not increasing over 2016. Most people without coverage in 2017 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.

Update And Compare Plans for 2017

People enrolled in the health insurance marketplace can re-enroll or choose a new plan for 2017.

Consumers should update their income and household information for 2017 and review all new insurances plans and pricing.

Even those who plan to keep their current plans should update their household information; it’s the only way to ensure any tax credits they may be eligible for in 2017 are accurate. Consumers can update household information now, though they can’t enroll in plans until Nov. 1.

Rising insurance premium rates are always a concern, Ravitz said, and 80 percent of consumers who enroll via the exchange receive financial assistance through tax credits.

“Consumers should check their options on the exchange,” she said, adding some “are leaving money on the table.”

The U.S. Department of Health and Human Services estimates 15,000 Connecticut residents could save money by using tax credits available through Access Health CT, according to a study the department released this month.

Plans and prices change each year and those who don’t research 2017 options may spend more than they need, get an outdated premium tax credit or be enrolled in a plan for which they are no longer eligible.

Ravitz also said small-business owners should explore AHCT options since it could save them as much as 35 percent off premium costs.

“A lot of small businesses in the state could qualify for financial help, and no one else can offer that,” she said.

Discounted Coverage

AHCT is the only place Connecticut residents can apply for financial assistance from the federal government to help pay for health insurance. People with moderate and low incomes can apply for tax credits toward monthly premium payments. Another subsidy lowers the cost of out-of-pocket expenses for deductibles, copayments and coinsurance.

Eligibility for discounted coverage depends on household size and income. Details about 2017 subsidies will be available on Healthcare.gov Nov. 1. Income cutoffs will be slightly higher this year, compared with last year, due to inflation, according to federal officials.

As a reference point, in 2016 people earning up to 400 percent of the federal poverty line ($46,680 for individuals and 95,400 for a family of four) qualified for tax credits.

In addition to tax credits, people earning 250 percent of the federal poverty line in 2016 ($29,175 for individuals and $59,625 for a family of four) qualified for subsidies to help with out-of-pocket costs—but only if they selected a health insurance plan from the silver category.

All plans sold at AHCT meet federal requirements to include essential benefits and cover at least 60 percent of all medical costs, so consumers get coverage that complies with the law.

Consumers can buy health insurance in the private marketplace. But the federal tax credits and out-of-pocket subsidies do not apply for private plans sold outside AHCT.

Here’s a look at some of the protections provided by the Affordable Care Act.

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.

Sources: Healthcare.gov, Access Health CT

This report was compiled by Cara Rosner.