Individual 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. For specific information on potential penalties, please visit IRS.gov.

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.

Connecticut’s Marketplace

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 5 categories – Platinum, Gold, Silver, Bronze and Catastrophic, 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.

Essential Benefits

• All insurance plans must cover a set of essential benefits.  These benefits include:
• Ambulatory care (outpatient) services
• Emergency services
• Hospitalization
• 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.