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Connecticut’s health exchange: a primer on details


NORTH STONINGTON — About two dozen people crowded the Wheeler Library basement last week to listen to author and health care consultant Randi Oster of Fairfield explain the new health insurance exchange that will be available to Connecticut residents.

Connecticut is one of 16 states, plus Washington, D.C., that is taking responsibility for its own insurance exchange, according to Oster. The exchange will open on Oct. 1, allowing residents without insurance, or small businesses who insure their employees, to buy health insurance online. About 244,000 residents, most between the ages of 18 and 34, will be eligible to buy insurance from the exchange.

Health care costs are high in Connecticut, Oster said, explaining why the state was eager to take control of its own insurance exchange. The state is ninth in the country, per capita, in Medicare spending, fourth in health care overall, and first in Medicaid spending.

On average, Connecticut residents now spend 21 percent more on health care and health insurance costs than the average U.S. citizen. And between the years 2000 and 2009, the cost of a family insurance plan rose 96 percent on average, while mean incomes rose only 13 percent, she said.

The Affordable Care Act, which in 906 pages, is not new, Oster noted. It was passed in March 2010, and some provisions went into effect three years ago, such as allowing young adults to stay on their parents’ health insurance plans until they reach the age of 26. However, the part of the law that creates insurance exchanges is just about to kick in. It brings new rules, new options, new subsidies, new penalties, and new premiums, she said.

The state’s insurance exchange, AccessHealthCT.com, will be open for enrollment from Oct. 1 to March 31. Insurance coverage will be effective on Jan. 1.

The number of companies offering insurance on the exchanges varies by state. Connecticut had four companies at one time, but Aetna dropped out in August, leaving only Anthem, Connecticare, and Healthy CT. Expect to spend about 45 minutes signing up, Oster said, and always make sure that the doctors you already see and the drugs you already take are approved on that plan.

“Don’t assume they are,” she said.

There are three levels of insurance offered on the site, bronze, silver and gold. The bronze plans pay 60 percent of costs, the silver pays 70 percent, and gold pays 80 percent. Some states also offer a platinum plan that pays 90 percent of all costs, but there are no platinum plans available on the Connecticut exchange. The prices are further modified by what county you live in, and how old you are.

Premium increases above 10 percent will trigger an automatic review by the Connecticut Insurance Department.

Subsidies to help people pay for insurance premiums are available for people who don’t have a plan available from an employer, who don’t receive Medicare, and who earn under a certain amount. The income ceiling varies by the number of people in a family. For a single person, the income is $45,960, and for a family of four, a household income under $94,200 will qualify for a subsidy.



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