Monday, May 20, 2013

Looking around at what health reform means in Connecticut

My note is to review and comment on some of the things we do know about the impact federal health reform will have here in Connecticut. There is a lot more for employers and individuals to learn, from not yet released regulations.

● The Health Insurance Marketplace here in CT, called an Exchange in the legislation, changed it's name to Access Health CT. Individuals can go to this site and review medical insurance plan options beginning in October and select coverage, which will be effective January 1, 2014.

● Federal health reform requires various market reforms in the Individual and Small group markets:
One is - all plans available, whether through Access Health CT or direct from a company, will be placed in one of four levels. Platinum, Gold, Silver, and Bronze. The coverage must meet 10 essential benefits. One of which is preventive dental coverage for children. Individual plans will no longer be subject to a review of medical history or pre-existing conditions and will include maternity coverage. These two requirements will result in the premium being higher.

Another - The premium for a person age 21 will have a factor of 1. The factor will increase year by year up to a factor of 3 for a person age 64. A couple on the same plan will each have a different premium if their age is different and there will no longer be male and female rates. Children from birth to age 20 will have a factor of .635. Today the spread from 20s up to 60s is about 5 to 1 which tells us the change to 3 to 1 means individuals in their 20s and 30s will see an increase in premium. Connecticut will allow the premium, for a person in the Individual market who smokes, to be increased up to 50%. The smoker factor will not be applied initially in the Small group market.

● Access Health CT approved the plan designs for the Individual plan market. The Silver level, the plan premium support is based on, has a $3,000 deductible. Preventive treatments are not applied to the deductible and do not have any cost to an individual. Expenses for various diagnostic office visits will not go toward the deductible but will have co-pays. Hospitalization will be applied to the deductible and will also have co-pays for the first few days of being admitted.

● Individuals whose income is up to 400% of the federal poverty level (FPL) can qualify for premium support if the buy a plan through Access Health CT. The maximum a person at 400% FPL, which is about $45,000 for a single person, will have to pay as their share of the premium is 9.5% of their W2 income.

● Individuals with a lower income will pay a lower percentage and those at about 250% of FPL will have lower plan co-pays and other improvements. The amount a person who qualifies for premium support pays is not connected to their age. Premium support will be sent from a federal agency to the medical insurance plan the individual selected. The company will then bill the individual, at home, the balance due (the 9.5% above) each month.

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