Friday, August 09, 2013

What's this about lower cost medical insurance for eligible individuals

Individuals in Conn will be able to submit an application when Open Enrollment begins this October to determine eligibility for lower cost medical insurance. They can apply for coverage to begin January 1, 2014 through Connecticut’s Health Insurance Marketplace, which is an on line enrollment site operating with the name Access Health CT.

I am pleased to share some points on eligibility and what the regulations to implement federal health reform say about how this new program will work:
● Eligibility is based on the person’s modified adjusted income (MAGI) and what it's percent of the Federal Poverty Level (FPL) is. Single individuals whose MAGI is at 400% of FPL (about $46,000) and below will be eligible.
● Individuals with dependents can also receive help based on their families combined MAGI. The maximum MAGI for a family of four would be $94,200. This is the 400% of FPL for a family.
● The share of the plan's premium for a single person making $40,000 is equal to 9.5% of their annual MAGI or $316.66 a month. The monthly share for a family of four whose MAGI is $94,200 would be $745.75. The monthly share for a person 22 and one who is 62 will be the same if each has the same income.
● The amount a person will be eligible for, which I call premium support, is calculated by subtracting, for example, the above Single individual’s $316 share from the premium for their age. If the premium was $600 it would be $284. Technically the amount a person qualifies for is an Advance Premium Tax Credit (APTC) and as a tax credit it will be reported to the IRS. Thus, a person will be responsible to reconcile this credit as part of their annual 1040 income tax report.
● The premium support or APTC amount is not based on the plan a person selects but only on the monthly premium of their second lowest cost Silver plan.
● The federal level Health and Human Services will send the individual's premium support to the medical insurance company they selected each month. This amount will vary based on a person’s age and the number of individuals they cover.
● The health insurance company will invoice them at home each month and they will pay their share on an after tax basis.

Initial plans for the application process was for a person to go to Access Health CT, enter personal and financial information, and while this was being done the system would:
● Interact with federal agencies, such as Homeland Security (citizenship), Social Security, and the IRS through a federal level data hub.
● Come back to them in real time and indicate, while still on line, if eligible for help and the amount they would have to pay each month. e.g. the above $316.
● Move them to the next step to review medical insurance plans from the three companies participating in the Individual plan part of Access Health CT. Eligible individuals will be able to select a plan, other than the second lowest cost Silver plan, which has more coverage by paying the additional premium.
● Then move them to the medical insurance company they selected to complete their enrollment.

As of today we do not know how much of the fully automated enrollment process will be available initially.

Want to take a look at whether you would be eligible for a premium discount and what your share might be? Go to There is a link to a savings calculator on the home page.

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