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Family Health Insurance Overview
With the passage of the Affordable Care Act, individuals have more options to purchase health insurance. A key provision of the Act, the Individual Mandate, requires individuals to have health insurance, either through a private health insurance plan or through a state or federally assisted program. If you don’t have insurance, you will pay a per month fee for each month you do not have insurance. If you have Medicare, you are considered covered and do not have to make any changes to your plan. Visit IRS.gov for up to date information on specific tax penalties.
Individuals and families can purchase health insurance through a marketplace, sometimes known as an exchange. At the Marketplace, individuals and families can learn about health insurance plans and their costs, including Medicaid and the Children’s Health Insurance Program (CHIP). When shopping for health insurance on an exchange, you will be informed if you qualify for Medicaid, CHIP or any other state or local public health program.
Access Health CT (AccesshealthCT.com) is Connecticut’s official health insurance marketplace. It provides information about qualified health care coverage options from health insurance companies and public health care programs. When purchasing insurance through the Marketplace, you may qualify for a tax credit and/or subsidy to reduce your cost sharing. You can also purchase health insurance outside the Marketplace and still be considered covered, however you won’t be eligible for tax credits or lower out-of-pocket costs based on your income.
On AccessHealthCT.com, you’ll find a variety of insurers with plans that are divided into 4 categories – Platinum, Gold, Silver and Bronze and, based on how you and the plan will share the costs of care. For example, a Gold Plan has a higher monthly premium but lower out-of-pocket costs; a Silver Plan has a lower monthly cost than Gold plans but higher out-of-pocket costs, and Bronze Plans have the lowest premiums but the highest out-of-pocket costs. The categories have nothing to do with the amount or quality of care you receive. All plans sold through the Marketplace provide the same essential health benefits, cover pre-existing conditions and provide free preventive services.
- All insurance plans must cover a set of essential benefits. These benefits include:
- Ambulatory care (outpatient) services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services, including annual physicals and mammograms
- Chronic disease management
- Pediatric services, including dental and vision
Open Enrollment is the period of time during which individuals who are eligible to enroll in a Qualified Health Plan can enroll in a plan in the Marketplace. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. For information on when Open Enrollment is, or whether or not you qualify for Special Enrollment Periods, visit AccessHealthCT.com.
Here is good advice about health insurance for families from the Connecticut Department of Insurance1:
Whether provided by your employer or purchased independently, health insurance can be expensive. Here are some ways you can control your costs:
- If you’re married and both spouses work at jobs that provide health insurance, compare policies and their costs to see which one best fits your family needs. Look beyond the monthly amount you might pay and evaluate covered services, co-pay requirements, deductibles and reimbursement levels to make the best choice for your family and your budget.
- Many health insurance plans offer a menu of options. Regularly review your family’s situation and adjust the options to meet changing needs.
- Stay in-network as much as possible, making sure to obtain referrals as required.
- Many plans require pre-certification for certain tests and procedures. Know your family’s plan and make sure you comply with these requirements to avoid paying penalties.
- Save all receipts for medical services. Even though your intent may be to always stay in-network, unexpected accidents, out-of-town emergency room visits or unexpected illnesses may cause out-of-pocket expenses that exceed even a high deductible.
- See if your employer offers a flexible spending account. These plans, which allow you to set aside pretax dollars for medical expenses and childcare, are often a good way to reduce your out-of-pocket medical costs.
- Finally, consider combining a high-deductible plan with a Health Savings Account (HSA). An HSA is a tax-sheltered savings account similar to an IRA, but earmarked for medical expenses. Deposits are 100 percent tax-deductible for the self-employed and can be easily withdrawn by check or debit card to pay routine medical bills with tax-free dollars. Larger medical expenses are covered by a low-cost, high-deductible health insurance policy. What is not used from the account each year stays in the account and continues to grow interest on a tax-favored basis to supplement retirement, just like an IRA. Some employers offer HSAs to their employees as a health insurance option.