Access Health Enrollment Starts; Uninsured To Face Steeper Fines

Open enrollment for consumers to buy health insurance through the Access Health CT marketplace begins Sunday, and 2016 will bring considerably steeper fines for consumers who lack insurance.

Access Health CT (AHCT), now in its third year, enrolled close to 100,000 individuals in private insurance plans in its first two years, according to Andrea Ravitz, director of marketing.

The marketplace aims to enroll between 105,000 and 115,000 in private plans by the end of open enrollment, Ravitz said. AHCT concentrated on attracting new enrollees its first two years but this year it has been focusing on retaining enrollees, she added. About 500,000 enrolled in Medicaid through AHCT, during the first two years.

Consumers, particularly those who are uninsured, may have noticed AHCT’s increased marketing efforts.

AHCT has increased its public awareness campaign, she said, including identifying 640 “community influencers” at more than 330 locations across the state to help spread the word. Those people include politicians, teachers, nurses, faith-based leaders and others within various communities that have a large uninsured population, she said.

The organization also reached about 270,000 people during the summer, when representatives attended dozens of community events statewide as part of a campaign to boost awareness, Ravitz said.

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, which runs from Sunday through Jan. 31, people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

For 2016, consumers can shop on the marketplace for plans offered by Anthem, ConnectiCare, HealthyCT and United Healthcare. Coverage begins as early as Jan. 1, but those who want coverage to start on that date must enroll by Dec. 15.

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 Sunday to enroll in plans, enrollment is open year-round to people who have experienced a qualifying life event, such as the birth of a child, a death in the household, a marriage, or a loss of coverage.

Also, enrollment in Medicaid (HUSKY) and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

The number of insured Connecticut residents is on the rise, according to U.S. Census Bureau figures and AHCT.

AHCT officials said earlier this month that an analysis by the marketplace found 3.8 percent of Connecticut residents are uninsured this year, down from 4 percent last year.

Census figures paint a slightly different picture, but still show steady improvement in the state. The Census estimates 7 percent of Connecticut residents lacked health insurance in 2014, down from nearly 10 percent in 2013, according to data released in September.

Paying The Price For No Insurance

Those who don’t have health insurance will face heftier fines in 2016. Most people without coverage in 2016 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 2016 returns in early 2017, and will be asked on their returns whether they had insurance coverage in 2016.

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

In 2015, consumers with no coverage will pay 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 the fine will see it deducted from future tax refunds.

Update And Compare Plans for 2016

People enrolled in the health insurance marketplace can re-enroll or choose a new plan for 2016.

Consumers should update their income and household information for 2016 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 2016 are accurate. Consumers can update household information as soon as Sunday.

Plans and prices change each year and those who don’t research 2016 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. Some may mistakenly get a higher tax credit than they qualify for, meaning they will have to pay back some or all of it when they file federal taxes.

“Go check your options,” Ravitz said. “There could be some extra savings.”

Rules Changing For Businesses

Under the federal law, employers with 50 or more full-time-equivalent employees must offer their full-time, eligible workers “minimal essential coverage” that is affordable, or face penalties.

Starting in 2016, however, “how you count those employees is different,” said Ken Comeau, senior vice president of the Connecticut Business & Industry Association. The change could result in businesses having to offer coverage to more workers.

Currently, businesses must provide insurance coverage to full-time workers if they have 50 full-time-equivalent employees, which historically has referred to those who work full time. But beginning Jan. 1, businesses must calculate their full-time-equivalents by taking into account all full-time workers and prorating hours worked by part-time employees, Comeau said.

The change will impact businesses that have few full-time employees but many part-timers, such as restaurants, he said. Full-timers work 30 hours a week or more; part-timers work fewer than 30 hours.

Additionally, through this year, businesses with 50 to 100 full-time-equivalent employees that haven’t offered the required coverage haven’t been penalized. But as of Jan. 1, that “transitional relief” disappears and businesses not complying with the law may face penalties, Comeau 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. People earning up to 400 percent of the federal poverty line ($46,680 for individuals and 95,400 for a family of four) qualify for tax credits.

In addition to tax credits, people earning 250 percent of the federal poverty line ($29,175 for individuals and $59,625 for a family of four) qualify for subsidies to help with out-of-pocket costs – but only if they select 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 are went into effect last fall. 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: In 2016, 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.

In 2016, once Medicare recipients and their plans have spent $3,310 on covered drugs, they will be in a coverage gap.

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:, Access Health CT, Connecticut Business & Industry Association

This report was compiled by Cara Rosner.