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Medicare Advisor, insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

Residents of Connecticut have many options when it comes to health care coverage. Insurance coverage can be obtained through your employer, you could buy an individual policy from an insurance company, or sign up for Medicaid or Medicare.

This guide explains your Connecticut health insurance coverage options in detail.

What to Know About Insurance in Connecticut

  • Marketplace plans: In Connecticut, you’re allowed to buy individual insurance policies if you’re not happy with your employer coverage, you’re self-employed, or are uninsured.
  • Open enrollment: The normal open enrollment period for the Health Insurance Marketplace starts on November 1 and ends on December 15 every year. If you miss this deadline, you’ll have to wait until the next enrollment period to apply for coverage unless you qualify for a special enrollment period (if you’ve been married or divorced recently, changed jobs, had children, or moved).
  • Health Insurance Marketplace: Connecticut has its own health insurance exchange, located at accesshealthct.com. If you want to apply for the Advanced Premium Tax Credit, you need to use the state Healthcare Insurance Marketplace. If you’re not interested in the tax credit, you can buy a plan directly from insurance companies serving Connecticut.
  • Coverage types: Just under 53% of people living in Connecticut have employer-sponsored coverage, and nearly 5% are covered by a non-group plan. Around 21.5% of the state’s population is enrolled in a HUSKY (Medicaid) plan, and 14% use Medicare. Just under 6% of people in Connecticut are uninsured.

How Do I Enroll in Connecticut’s health insurance marketplace?

Connecticut is one of 14 states that runs its own health insurance marketplace. To enroll using the exchange, you can visit the Access Health CT website and create an account. The process is very simple and requires that you provide your contact information, security questions, and a password. Once you’ve set up your account, you can apply for health insurance. Make sure that you have the full name, birth date, and Social Security number for every person you intend to enroll under your insurance plan. The website automatically determines whether you qualify for programs like Medicaid or other forms of financial assistance. You can also see whether you qualify for the Advanced Premium Tax Credit. There are several questions you need to answer to determine your eligibility for benefits:

  • Are you married or single?
  • How many dependents did you claim on your last tax return?
  • What is the total income for your household?
  • Would you like to apply for financial assistance?

The next step allows you to compare insurance plans on the exchange to determine which one is right for your family. When you review plans, you can see the annual deductible, copayment requirements, and monthly premium for each insurance policy. Once you’ve found a plan that works for you, simply complete your enrollment in that plan. Two insurance companies offer plans to Connecticut residents in the Health Insurance Marketplace:

  • Anthem
  • ConnectiCare

How do I enroll in Connecticut individual and family insurance?

There’s no difference when it comes to enrolling for coverage as an individual versus seeking family coverage. However, you do want to consider your needs and how all of the members of your household are going to benefit from your insurance plan. These considerations include:

  • Medical needs
  • Preferred plan type
  • Premium affordability
  • Individual vs. family deductibles

Insurance for individuals in Connecticut 

You’ve got a lot more flexibility when seeking individual coverage. Because your needs are the only ones you have to consider, you can save money with policies that require higher deductibles and copayment requirements. Just remember that your benefits may be limited until your deductible is met for the year, so if you do wind up needing medical care, it could cost more.

The type of plan that you choose impacts your cost of insurance and how restricted your access to care is.

  • Health Maintenance Organization (HMO) plans are the cheapest policies, but you’re required to only see doctors inside of the plan’s network. When you wish to see a specialist, you’re required to get a referral.
  • Preferred Provider Organization (PPO) plans offer you the freedom to see whatever doctors and specialists you’d like to with the drawback of higher monthly premiums.
  • Point-of-Service (POS) plans combine the benefits of HMOs and PPOs by providing you a network of doctors to visit and requiring referrals for specialists while also allowing you to see doctors outside of the network if you pay a higher copayment.

Insurance for families in Connecticut 

Shopping for family coverage is a little more difficult because you’re looking to reduce the total cost of health care for everyone on your plan. Each member of your household may have different needs for you to consider. If your spouse or one of your children suffers from a chronic medical condition, you’ll need to consider how often they’ll need access to specialist care and state-of-the-art treatments.

If your family members need regular access to medical care, you need to balance your deductible, coinsurance requirements, and monthly premium to come to an effective solution that reduces the total cost of care for your entire family. You might be tempted by a low monthly premium when a more expensive plan actually saves you more money by reducing your out-of-pocket expenses.

When you’re considering the type of plan to purchase, review each plan’s network to see if you really need a PPO. If you feel that a POS or HMO network has an extensive selection of specialists that cover your family’s needs, you might save money by purchasing one of these plans. If you’re set on having the freedom to see whatever doctor you’d like to, consider a PPO plan.

How much does health insurance cost in Connecticut?

When you shop for insurance on the Health Insurance Marketplace, you’ll notice that plans fall into four tiers: bronze, silver, gold, and platinum. The tiers are organized by the type of coverage you receive, your annual deductible, coinsurance requirements, and monthly premium. The cheapest coverage isn’t always the best coverage because your needs may require a more comprehensive plan to effectively reduce your total out-of-pocket expenses.

Average premiums in Connecticut 2018 2019 2020 2021
Most affordable bronze plan $341 $336 $340 $368
Most affordable silver plan $543 $448 $547 $523
Most affordable gold plan $607 $574 $533 $489

  • Bronze plans cost the least in premiums every month. The drawback to a bronze plan is that it also requires a high deductible and copayment. Each time you require medical care, you’ll be responsible for 40% of the cost after meeting your deductible. If you’re healthy and don’t require ongoing medical treatment, a bronze plan is a good way to reduce your expenses in the case of a sudden hospital visit. These plans aren’t appropriate if you or a family member have a chronic health condition. The most affordable bronze plan in Connecticut costs $368 per month in 2021.
  • Silver plans are more expensive than bronze plans, but you benefit from lower annual deductibles and copayment requirements. You’re only required to pay a 30% deductible when you receive medical treatment. There are cost-sharing plans available that allow individuals to purchase a silver plan for less than the cost of a bronze plan in some instances. To qualify, your income needs to remain under a certain threshold determined by your household size. The most affordable silver plan in Connecticut costs $523 per month in 2021.
  • Gold and platinum plans cost the most each month, but they have the lowest deductibles and coinsurance requirements. A gold plan requires a 20% copayment whenever you receive medical care, and your copayment is reduced to 10% if you enroll in a platinum plan. In Connecticut, some gold plans may actually be cheaper than silver plans. This allows you to purchase more comprehensive coverage for around the same monthly premium. Gold and platinum plans are primarily for families caring for one or more members with a chronic health condition. The most affordable gold plan in Connecticut costs $489 in 2021.

What kind of low-income health insurance is available in Connecticut?

Connecticut has four programs to help residents throughout the state who are unable to afford health coverage: HUSKY A (Medicaid), HUSKY B (CHIP), HUSKY C (Medicaid for the disabled), and HUSKY D (Medicaid for families with very low income). Your eligibility for each program depends on your age, income, and your household size.

HUSKY A in Connecticut 

HUSKY A is the state Medicaid program for residents who are caring for one or more minor children. It covers preventative care, outpatient services, emergency care, and medication for families that qualify for the program. To enroll, your household income must remain under the threshold for your family size.

HUSKY B in Connecticut 

The Connecticut Children’s Health Insurance Program is also referred to as HUSKY B. It covers children under 19 years of age and pregnant women. If you qualify for HUSKY B, you’re covered for preventive care, medications, immunizations, dental care, vision, mental health care, hospital visits, prenatal care, and annual physical examinations. The CHIP program also connects your children with physicians and specialists throughout the state to treat a wide variety of medical conditions.

To see if you qualify for HUSKY A, B, or D in Connecticut, you can visit the member portal and apply for coverage. If you’d like to apply for HUSKY C, there is a separate portal that you can use to file your application.

HUSKY C in Connecticut 

HUSKY C is Connecticut’s Medicaid program for seniors and residents with disabilities. To qualify, you must be over 65 years old, have a permanent disability, or provide care to someone who is disabled. The income thresholds for this program depend on which part of the program you apply to, but the maximum income for any household to qualify is $75,000 per year.

HUSKY D in Connecticut 

HUSKY D is Medicaid for residents with the lowest incomes. To qualify for HUSKY D, your income can’t exceed $17,774 if you’re applying as an individual. The income threshold increases with household size. For example, a family of three can qualify as long as your total household income is under $30,305, and a family of five can qualify if your household income is lower than $42,835.

What are Connecticut’s Medicare options for seniors and people with disabilities?

If you’re over the age of 65, you live with a disability, or you care for someone with a disability, you’ve got several Medicare options available in the state of Connecticut.

  • The first option is Original Medicare, which is made up of Part A and Part B. Medicare Part A covers inpatient care, which includes hospital stays, nursing or assisted living care, home health care, and hospice care. Medicare Part B covers outpatient procedures, preventive care, physical examinations, diagnostic testing, medical equipment and supplies, and more.
  • Medicare Advantage Plans are offered by insurance companies and allow you to add coverage you’d otherwise not receive with Original Medicare. For example, you can select an Advantage plan that covers vision and dental care. Not every Advantage plan covers prescription medications, but some do. If you need prescription coverage, you can also enroll in Medicare Part D.

Medicare Supplement plans cover your out-of-pocket expenses, such as your deductible and copayments not covered under your Medicare plan. If you’re unsure of whether you can afford your health care, enrolling in a Medicare Supplement plan can further reduce your medical expenses.

Eligibility

To be able to enroll in Medicare you either need to have a permanent disability, have been disabled for more than 24 month, or be over the age of 65. Medicare is also only available to United States citizens or permanent residents. If you’re over 18 years old and require nursing care or are suffering from end-stage renal disease, you might also qualify for Medicare.

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • Medicare Advantage open enrollment: You can enroll in Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can enroll, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources 

If you have questions or need assistance with your Medicare enrollment, you can reach out to the Centers for Medicare and Medicaid Services or call the Connecticut CHOICES Program at 800-994-9422.

Are there short-term health insurance plan options in Connecticut?

Due to Connecticut’s strict laws regarding short-term health insurance plans, no insurance companies offer short-term plans in the state.

Connecticut Insurance FAQs

Does Connecticut require health insurance?

You’re not required to purchase health insurance in Connecticut, but the Affordable Care Act does have a mandate for insurance coverage at the federal level. Since 2019, the penalty for not being covered has become unenforceable. Despite this, it’s still a good idea to have health insurance.

Do I have to use the Health Insurance Marketplace in Connecticut?

You’re free to purchase insurance from any company you wish. If you’re looking for financial assistance or to take advantage of the Advanced Premium Tax Credit, the Health Insurance Marketplace is the only place you can purchase insurance from that provides these benefits.

What types of alternative health insurance plans (like cost-sharing plans) are available in Connecticut?

You might be able to save some money if you’re able to qualify for alternative health insurance plans that pool members’ resources. Medical claims are paid out as needed whenever you need them. However, these plans are not insurance and do not have to conform to ACA requirements.

Do I need health insurance if I have HSA/FSA?

Health savings accounts or flexible savings accounts are a great supplement for health insurance, but you’re unable to use them to reduce your medical expenses whenever you require treatment. It’s a good idea to use an HSA or FSA to save up in case you’re hit with significant out-of-pocket expenses due to a hospital stay. However, these accounts aren’t an adequate replacement for health insurance.

Do I need short-term disability coverage in Connecticut if I have health insurance?

Short-term disability insurance helps you out if you’re hurt or fall ill and can’t return to work. While your health insurance covers most of your medical expenses, you may struggle to pay your bills and buy groceries. For example, if you’re injured at work, your health insurance and worker’s compensation benefits pay for your emergency room visit and rehabilitation but only a portion of your lost wages. A short-term disability plan covers the expenses you’re left with while you’re unable to earn a paycheck.

Do I need long-term disability coverage in Connecticut if I have health insurance?

Long-term disability coverage works in the same manner as short-term disability coverage. For the same reasons, it’s a good idea to carry long-term disability coverage so that you can continue to make your mortgage payments, pay your utility bills, and put food on the table if you’re injured or diagnosed with a condition that keeps you from working.

What does CHIP cover?

Connecticut’s HUSKY B (CHIP) program covers children under the age of 19 and pregnant mothers for the cost of regular doctor visits, diagnostic testing, physical examinations, mental health care, prenatal care, dental visits, vision care, speech and hearing therapy, immunizations, emergency care, and approved outpatient procedures. The program also covers the cost of prescription medications.

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