Connecticut residents deserve affordable and comprehensive health insurance just like anybody else. But sometimes, finding such coverage is easier said than done. That’s where we come in. Below, we’re going to talk about all of your options, including: major medical through the ACA, Christian health plans, short-term health insurance, and more. So if you’re overwhelmed by the number of options available to you and having trouble making a decision, you’ll be doing yourself a disservice if you don’t keep reading!
Major Medical Insurance in Connecticut
The patient protection and Affordable Care Act goes by many names: the Affordable Care Act, Obamacare, the ACA, and more. But the truth is this legislation has saved millions of lives helping people purchase what would be otherwise unaffordable health care coverage, leaving many people with the impossible choice of either going without care or going into devastating medical debt. Instead, they can sign up for a subsidized policy via the Health Insurance Marketplace and get a wide array of health-promoting benefits and care at a reasonable price.
In Connecticut, you start by submitting an application through Access Health Connecticut (AHCT), the official health insurance marketplace. Some residents may be able to apply for Open Enrollment through January 15th, 2020; but for coverage that starts January 1st, the deadline is December 15th, 2019. Financial help may be available depending on your household size and your Modified Adjusted Gross Income (MAGI).
Before we go any further, it’s important to mention the two most important differences between a major medical plan purchased through a health insurance marketplace, and the other options you’ll see below. The first difference is that official marketplace insurance policies are what’s known as “guaranteed issue” policies. This means two things: when you apply for coverage, you cannot be denied for any reason. It also means that your insurance provider cannot use pre-existing conditions or your sex as an excuse to charge you more. The only personal factors which could potentially make your premium more expensive are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
The next most important thing is the list of Guaranteed Essential Health Benefits that you get with a federally regulated major medical policy. Every policy offered through a marketplace exchange must offer these benefits, or it cannot qualify as sufficient coverage:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
The Connecticut State Exchange
Qualifying for financial assistance is easier in Connecticut because the state was one of the early adopters of federal funds designed to expand Medicaid availability to low-income households. What this means is that if you are a single person making less than $49,960 per year, you can qualify for a subsidy; alternatively, if you’re a single person making less than $17,236, you will likely qualify for Medicaid. Either way, you have nothing to lose by filling out an application and checking to see what benefits you may qualify for and whether or not a health plan from the Connecticut Exchange is an economically viable option for you.
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If it turns out that you don’t qualify for a subsidized major medical plan through the state exchange, you might qualify for Medicaid through the HUSKY program. HUSKY A, HUSKY C, and HUSKY D are for adults, parents, pregnant women, and caretakers who meet a certain income threshold. HUSKY B is Connecticut’s version of the CHIP health insurance program for children. For more info, you can contact the State of Connecticut Department of Social Services.
Short Term Health Insurance in Connecticut
Connecticut is one of several states in which short-term health insurance providers are no longer doing business. Within the last few years, many states – Connecticut included – have been passing strict regulations in an attempt to make short-term health insurance policies look and operate more like ACA-compliant coverage. But for some providers, this makes their business model unprofitable and they stop offering policies in states which pass such strict regulations. But just because short-term health insurance isn’t available in Connecticut anymore doesn’t mean you don’t have health care options. If you can’t or don’t want to go through the Exchange, you may want to take a look at a Christian health plan or a health share plan, among other things.
Christian Health Plans/Health Share Plans in Connecticut
Once upon a time, there used to be a law on the books referred to as the individual mandate. This law mandated that individuals either purchase an ACA Marketplace plan, get health insurance through their employer, or purchase an independent qualifying health care plan from somewhere else. For better or worse, Christian health plans became very popular because their religious nature granted them a qualifying healthcare plan exemption for people who couldn’t or didn’t want to get health insurance through their employer or through the ACA Marketplace. Since the individual mandate is no longer the law of the land with the exception of Washington DC, Massachusetts, and Vermont, the need to purchase a Christian health plan has been in decline over the last couple of years.
The reality is that Christian health plans are modeled very closely after short-term health insurance. And now that short term health insurance is no longer a viable option in Connecticut, they may see a resurgence in popularity. But there are some important differences between the two. Let’s start by taking a look at what these two plans have in common:
- Not guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
Now let’s take a closer look at the differences between them. With a Christian health plan, you don’t pay a monthly premium, co-pays, deductibles, or co-insurance; instead, you pay a “monthly share amount” and you may also have to pay a “responsibility amount” or an “unshared amount” in addition to your monthly share amount depending on the care you need and the benefits you use. This semantic difference stems from the fact that, legally, there is no contract between you and your Christian health plan provider. So if they decide they don’t want to pay out on a specific claim or limit your benefits, your option for legal recourse is extremely limited if not nonexistent. Lastly are the “participation guidelines” which Christian health plan members are expected to follow. These guidelines include things like a prohibition of tobacco use, the declaration of a specific (usually Christian) faith, and other biblical lifestyle habits.
Fixed Indemnity Plans in Connecticut
Let’s get one thing out of the way: fixed indemnity plans are not a legitimate replacement for major medical insurance, especially if you live in a state that still enforces the individual mandate. That being said, they aren’t without value. Lots of consumers turn to fixed indemnity plans to help pay for hospital expenses on a per day, per week, per month, per visit, or per incident basis. Some states may even have fixed indemnity doctor plans available for things like preventative care and annual check-ups. But most consumers shouldn’t rely on such plans to replace major medical coverage. There are several important reasons for this.
For one, they come with many of the same limitations that a Christian health share plan or a short-term health insurance plan does: lifetime/annual benefit caps, medical underwriting, and a lack of provisions for Essential Health Benefits. This means that your premiums could cost substantially more money if your insurance provider believes you have a pre-existing condition. It also means that you might not be eligible for certain types of coverage even if you would like to purchase it, or that your insurance company may decide to stop paying out benefits when you need treatment the most. Fixed indemnity plans are actually sold most frequently in order to supplement major medical care. But if you can’t get major medical insurance, there’s a chance that these fixed indemnity plans could help reduce your out-of-pocket costs.
Discount Cards in Connecticut
Have you heard of medical discount cards? They work similarly to an AARP or AAA discount card. All you have to do is sign up for a membership, pay your membership fees on a monthly or annual basis, and you will get a discount card sent to you in the mail. When you get medical care at qualifying retailers, pharmacies, medical providers, and more, you show them the card at the register and you will get a certain amount discounted from your total bill. Best of all, it doesn’t matter if you already have major medical coverage or not; these cards are available to anyone who’s willing to pay the membership fee.
But that doesn’t mean all medical discount card programs are created equal. You should do your due diligence and look into the medical discount card company and the claims they make before you sign up for anything. Connecticut does a better job than most states trying to keep tabs on medical discount card providers and protecting consumers from scams; but that doesn’t mean scams don’t still exist. Be on the lookout for suspiciously generous discounts, and make a few phone calls to double-check and see whether or not the providers that the discount card company claims to be affiliated with will actually honor your promised discounts. If anything seems suspicious to you, be sure to contact the Connecticut Insurance Department to report a potential scam.